chat transcipt - neuro and gross anatomy

[Anonymous]

20:57:06 [Lorena] hi crusher

20:58:17 [crusher] hi lorena.

20:59:08 [crusher] you was absent in last discussion,i hope u followed the transcrpit

20:59:10 [Lorena] ready for neuroanatomy?

20:59:28 [Lorena] yes, it was a very good chat i could see

20:59:34 Step_1 enters this room

20:59:35 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

21:00:05 [Step_1] hi lorena and crusher

21:00:14 [Lorena] hello step 1

21:00:20 [Lorena]

21:00:50 [Step_1] hope you guys are having a great memorial day weekend

21:01:03 [Lorena] i wont participate tonight ...i was not able to finish my first reading so i will just listen to you guys

21:01:12 hutals enters this room

21:01:25 [crusher] hi step1

21:01:47 [Step_1] as long as you're learning

21:02:45 Roxanita enters this room

21:02:52 [Step_1] did you guys get the chance to look at some of those old anatomy questions with pics?

21:02:58 [Lorena] hi hutals and roxanita

21:03:13 [hutals] hello everyone.

21:03:42 [Roxanita] hi

21:03:42 [crusher] yes i did.n thanks a lot step1 for putting them up

21:03:59 [hutals] sorry i'm always silent observer, but i feel like i'm behind. i learn alot from you all. thanks

21:04:15 [Lorena] yes they are great thanks step1

21:04:33 [Step_1] i'm a visual person, so the pics really help me alot. helps stick better

21:04:48 [Lorena] hutals , as step 1 says...as long as we are learning! thats what counts

21:05:16 [Roxanita] Hutals by coming here don't you feel a little more motivated?

21:06:12 [hutals] oh yes. i try to keep up with my readings. i just dont participate because i feel like i dont know enough yet. but i'm getting there

21:06:32 acestep1 enters this room

21:06:34 [Lorena]

21:06:49 hutals exits from this room

21:06:49 [Lorena] hi ace, nice to see you again

21:06:54 hutals exits from this room

21:07:04 [acestep1] hey lorena

21:07:10 [acestep1] how r u

21:07:16 [acestep1]

21:07:28 hutals enters this room

21:07:44 [Lorena] very good thanks

21:07:46 [Roxanita] so that's enough for everybody, as long as we can improve just a little our study and review of subjects this group is working

21:07:50 [hutals] i was trying to bring vladi from the other room, but no reply

21:08:23 [Step_1] i guess we can get started, ppl usually join late, although it is a holiday weekend.

21:08:26 [Lorena] i will just be observer today cauze i didnt finish reading

21:08:42 vladi enters this room

21:08:50 [Roxanita] same here

21:08:59 [crusher] xzhi vladi

21:09:15 [Step_1] thats ok, particpate as you feel comfortable

21:09:22 [vladi] hi guys

21:09:27 [Step_1] hi vladi.

21:09:33 [Lorena] hi vladi

21:10:08 [vladi] neuro

21:10:20 [crusher] time is always short for discussions

21:10:41 [crusher] neuro

21:10:57 [Step_1] ok, ventral root ganglia....motor or sensory?

21:11:10 [acestep1] mtor

21:11:18 [Lorena] motor

21:11:34 [crusher] motor

21:11:36 [vladi] what's the best free website for neuroimaging

21:11:50 [crusher] webpath

21:11:53 [vladi] motor

21:11:54 [Step_1] thats right. and dorsal root ganglia is sensory

21:12:06 [acestep1] yup

21:12:17 [acestep1]

21:12:33 [Step_1] i think i have something written down about that vladi, i'll post it if i find it

21:13:01 [Lorena] i will post some cool sites too, there are a bunch

21:13:16 [acestep1] k

21:13:22 [vladi] thanks

21:13:40 [Step_1] lumbar splanchnic nerves....what level of cord? what ganglia?

21:14:06 [Step_1] also, is it sympathetic or parasymp?

21:14:17 [vladi] HY Q- difference in UMN and LMN in terms of manifestation and location

21:14:57 [Lorena] L1,2 pre vertebral ganglia

21:15:25 [Lorena] sympathetic?

21:15:48 [Step_1] yes lorena paravertebral, but close enough. and sympathetic....very good

21:15:56 [crusher] UMN ,LESION inc reflexex + babiski,falidic,,LMN .inc tone,faciculation,-ve babisnki,dec reflexes

21:16:22 [vladi] it's visceral

21:16:43 [Step_1] UPN is everything pos like Spastic paralysis, hyperreflex, =babinski, inc muscle tone

21:17:05 [acestep1] agree

21:17:17 [Step_1] LMN everything is dec like flaccid paralysis, areflex, - babinski, dec muscle tone

21:17:22 [acestep1] n a large gp of muscles r incolved

21:17:42 [acestep1] n disuse atrphy in uml

21:17:57 [acestep1] atrophy imean

21:18:28 [Step_1] which is only thing spinal cord lesion dz that will have BOTH UMN and LMN at same time?

21:18:58 [acestep1] amyotropic lat sclerosis

21:19:04 [crusher] amylotrophic lateral sclerosis

21:19:23 [vladi] great- from <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>FA</a> LMN- everything lower, UMP- up (tone, toes-Babinski etc)s

21:19:32 [Step_1] yes, "ALS has it ALls"...everything in Upper and lower affected

21:19:44 [acestep1] ok1 q

21:20:11 [acestep1] umn lesions r ipsilat or contralat

21:20:39 [crusher] bocontralateral=UMN

21:20:56 [Step_1] contra if brainstem and above. ipsilat if in spinal cord

21:21:07 [acestep1] yes v gd

21:21:16 [crusher] cos fibers decussate in lower medulla

21:21:31 [vladi] as for location- LMN are in dorsal horn of spinal cord or any point distal to this structure, UMN-frontal lobe, brainstem, cervical corticospinal tract, any point that is proximal to the upper cervical spinal cord

21:21:33 [Step_1] whereas LMN are ALWAYS ipsilateral

21:21:43 vbx enters this room

21:21:52 [Step_1] hi vbx

21:22:13 [vbx] hi

21:22:15 Lorena enters this room

21:22:31 [acestep1] valadi im not sure abt this

21:22:41 [Step_1] which tract involved with voluntary refined movements of distal extremity?

21:23:06 [acestep1] from wht i remb umn - brainstem n motor n areas 1,2,2 of teh brain

21:23:10 [vladi] where- step 1

21:23:29 [Lorena] corticospinal tract

21:23:41 [Step_1] sorry, i missed the question vladi

21:24:55 [vladi] i took it from 2500 Q of McGraw-Hill at usmleasy

21:25:11 julieog1 enters this room

21:25:30 [Step_1] any point prox to upp cord?

21:25:56 [julieog1] Step_1> Step_1

21:26:09 [Step_1] hi julie

21:26:43 [julieog1]>[Step_1] /TO Step_1

21:26:43 [Step_1] btw lorena is correct....corticospinal tract is correct

21:26:57 [vladi] i asked acestep1 whereas LMN always ipsilateral

21:27:30 [Step_1] ok, i was confused.

21:28:03 [Step_1] which tract for fine touch, vibration, pressure?

21:28:07 [vladi] sorry step 1

21:28:21 [julieog1] dorsal column

21:28:28 [Lorena] medial lemniscal system

21:28:50 [acestep1] oh sorry valadi

21:28:58 [Step_1] yes, dorsal column aka medial leminiscal

21:29:04 [Step_1] pt stumbles in dark but ok in light, which pathway?

21:29:12 [acestep1] its in caplan valadi

21:29:35 [crusher] cortibular fibers are usually bilateral tell me where they are unilateral

21:29:43 [Lorena] spinocerebellar?

21:29:51 [acestep1] wow step1 gd q

21:30:15 [crusher] cerebellar lesion pos babinski sign

21:30:21 [Step_1] this was actual question a couple of times...very high yield. rather than ask about rhombergs sign, they decribe someone who falls when cannot see (no sensation in feet)

21:30:23 [acestep1] 7 nerve n 12 th nerve

21:30:33 [crusher] i,m sorry pos romerg sign

21:30:39 [acestep1] wow

21:30:50 [Step_1] so its the dorsal column because thats the sensation pathway

21:31:09 [acestep1] ic i never thought of it tht way

21:31:54 [Step_1] rule of thumb...if eyes closed and fall-> rhombergs dorsal column. if eyes open and fall-> cerebellar

21:32:10 [vladi] very tricky Q, step1-thanks

21:32:11 [acestep1] yes v true

21:32:35 [Lorena] nice

21:32:56 [crusher] v.cool step1

21:33:00 [Step_1] sensation to the lower limb is by gracilis or cunneatis? is that medial or lateral part of dorsal column?

21:33:27 [acestep1] gracilis

21:33:32 [vbx] gracillus

21:33:38 [Lorena] gracilis for lower limbs and lower trunk

21:34:01 [crusher] gracilis and medial

21:34:17 [Lorena] it is medial

21:34:32 [Step_1] graccilis is the medial part of DC and goes to lower limb. the lateral part if the cuneatus and goes to upper limb. picture a person where legs are close together but ams are further apart. good job!

21:34:39 nne enters this room

21:34:51 [Step_1] hi nne

21:35:03 [nne] hi everyone sorry i'm late

21:35:13 [Step_1] which tract for pain and temp?

21:35:14 [acestep1] np nne

21:35:16 [Lorena] hi nne

21:35:23 [nne] Dosal tract

21:35:28 [crusher] spinothalamic

21:35:32 [acestep1] lat spinothalamic for body

21:35:38 [vbx] lateral spinothalamic

21:35:42 [vladi] Q- in the medial lemniscus of the open medulla, projections from n.cuneatus are located more ventrally (anteriorly) than those from the n.gracilis- true or false

21:36:27 [crusher] true

21:36:38 [Step_1] false

21:36:47 [Lorena] agree spinothalamic for pain and temp

21:37:07 [Step_1] nevermind...true

21:37:10 [acestep1] i thinj false

21:37:27 Roxanita enters this room

21:37:46 [crusher] cortibular fibers are bilateral where they are unilateral

21:37:50 [Step_1] i'm looking at the pick and cant figure out which is ant

21:38:08 [acestep1] hehe

21:38:09 [vladi] great step 1- axons from n.gracilis make up the ventral portion of the medial lemniscus in the medulla

21:38:23 [acestep1] awwwwwww

21:38:29 [acestep1] im wrong

21:39:03 [acestep1] oh ok im right

21:39:05 [Step_1] LMN

21:39:12 [acestep1]

21:39:20 [vladi] acestep1- you alswo great

21:39:55 [acestep1] thnx

21:40:04 [acestep1]

21:40:52 [acestep1] i think facial nerve n hypoglosaal seomtimes

21:41:02 [Step_1] let me correct myself again....UMN deficit will be unilat whereas bilateral...is that right?

21:41:40 [vladi] let's move on eye nerve disorders-HY

21:42:08 [acestep1] hey step1 can u repeat wht u said . ididnt get u

21:42:10 [crusher] actually cortico bulbar fibers connect UMN to LMN,they are bilateral except in lower face where they are unilateral

21:42:12 [Step_1] what is the ans crush?

21:42:43 [Step_1] thx

21:43:17 [Step_1] i was trying to ans crushes question....apparently typing before i think it through

21:43:25 [crusher] rember in fascial nerve palsy bcos of cortex lesion is only contralateral lower face effected

21:43:26 [acestep1] ya . only the lower face is not supplied by bilat corticobulbar innervation

21:43:46 [acestep1] k. np step1

21:44:21 [acestep1] yes but in faial palsy otehrwsie the whole face ipsilat is affected

21:44:27 [Step_1] yes....if the UPN to the face is damaged, the LMN will still supply the lower face

21:44:34 [acestep1] facial palsy imean

21:45:25 [vladi] it's very HY- difference between central and peripheral faciaql palsy- i got it on real exam

21:45:35 [crusher] differntate the basic difference of coomunicating n non communicating hydrocephalus

21:45:56 [acestep1] yesv true vladi

21:46:13 [crusher] i nknow vladi.

21:46:14 [vladi] better source- is in <A target=new HREF="http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20">First Aid</A>

21:46:39 [Lorena] comunicating is for oversecretion of CSF or absorption problems

21:46:55 [acestep1] in noncommunicating the foramen of monro or lushka is obs

21:47:00 [Lorena] noncomunicating is caused by obstruction flow

21:47:02 [Step_1] non communic is obstruction of csf proximal to foramina of luschka and magendie (usually at cerebral aqueduct). this prevents comm with subarach space

21:47:11 [acestep1] yes agree with lorena

21:47:40 [Step_1] comm has subarach space and cisterns in comm with ventricles

21:47:46 [acestep1] yes now i remb

21:48:25 [vladi] crusher it's also HY- noncommunicating when Sylveus ductus id obstrcuted, i.e . no communication between 3rd and 4-rd ventricles

21:48:34 [crusher] yes non communicating is obstruction in ventricles or its connections while communicationg is oversection or absorption problem e.g in subarachinoic spcee,

21:49:33 [acestep1] ok eg of cerebral aqueductal obs

21:49:42 [acestep1] ?????

21:50:16 [crusher] what the problem in normal pressure hydroceplus?

21:50:37 [crusher] non communicating hydrocep

21:51:14 [Lorena] CSF is not getting absrobed by arachnoid villi

21:51:22 [acestep1] perinuands tumour

21:52:16 [vladi] when CSF is not absorbed by the aracnoid villi. Remember 3 w; wacky, wobby and wet(incontinence)

21:52:33 [acestep1] i think its a triad of dementia , urinary incontinence n ataxia

21:52:42 [Step_1] obstruction would be the difference. the 3rd ventricle is often enlarged in noncommunicating if obstruction is at aqueduct

21:52:47 [crusher] yes lorena cSF is not absorbed by subarachinoid villi and ventricles are enlarge ,present with confusion,ataxia,and incontinenece

21:53:11 [Step_1] which aphasia has comprehension preserved and which has comprehension impaired?

21:53:13 [crusher] good neominic vladi

21:53:44 [crusher] brocas intact ,wernicki impaired

21:53:54 [vbx] sensory brocas

21:54:24 [acestep1] expressive has i think wernickes preserved

21:54:32 [Step_1] BROCa's aphasia has BROKen speech, but comp is intact. wernicke's has impaired comprehension....like the drunk guy with wernicke's

21:55:27 [Step_1] expressive is brocas and reseptive or sensory is wernicke's

21:55:29 [Lorena] Broca is very frsutrating for the patient because he can understand m wernicke , he doesn realize his impairment

21:55:52 [acestep1] yes

21:56:34 [crusher] which tracts 2nd order neuron are very close to first order neuron?

21:56:44 [acestep1] also i think when coprus callosum lost we cant comprehend

21:57:00 [Lorena] pain and temperature tracts

21:57:25 [Lorena] (spinothalamic)

21:57:35 [vbx] lateral

21:57:44 [acestep1] agree

21:57:59 [crusher] very good spinothalamic tract they decussate early so lesions are usually contralateral

21:58:40 [Step_1] if they show you a pic and you can figure out that its the ant cerebral art damaged, what impairment...upper or lower limbs?

21:59:03 [acestep1] upper limbs

21:59:07 [crusher] loer limbs are effected

21:59:37 [Lorena] lower limbs

21:59:41 [acestep1] oops sorry

21:59:51 [acestep1] yes lower limbs

22:00:04 [crusher] which tract fibers donot decussate?

22:00:05 [acestep1] cuz of teh homunculus

22:00:21 [Step_1] this was another real question which shower pic and first you need to recognize that ACA is medial. then realize in the humuncus that medial affects LL. The middle cerebral would affect the upper limbs

22:00:38 [Lorena] spinocerebellar tract doesnt decussate

22:00:46 [acestep1] yes

22:00:59 [acestep1]

22:01:13 [vladi] lower limbs, of course

22:01:25 [crusher] yes spino cerebellar fibers donot decussate n lesion is ipsilateral

22:02:13 [crusher] e.g is freiedreich ataxia

22:02:33 [Step_1] pour cold water into left ear of pt would produce nystagmus to which side?

22:02:57 [acestep1] opposite

22:03:06 [acestep1] cows i remb

22:03:19 [crusher] COWS.cold opp and warm same

22:03:29 [acestep1] yes

22:03:40 [Step_1] it would produce right nystagmus because of mneumonic COWS or Cold Opposite Warm Same....very good

22:03:41 [Lorena]

22:04:35 [crusher] lesion is at level of T10.tell me what effect on dorsal column ,CST and spinothalamic tract in terms of (ipsilateral and contralaeteral)

22:05:31 [Lorena] hemisection of t10?

22:06:13 [crusher] tes lorena hemisection on T10

22:06:31 [vladi] is it total dissection

22:06:38 [Step_1] dorsal column crosses at brainstem, so this would be same side for movements since after cross....

22:06:41 [Lorena] hemisection of t10 = 2 ipsilateral signs and 1 contralateral

22:07:14 [vbx] pain temp contralateral

22:07:25 [Step_1] same with DC (sensation). but contra with spinothalamic (pain and temp)

22:07:44 [Lorena] loss of touch , etc ipsilateral; spastic weakness ipsilateral too and loss of pain and temp contralateral

22:07:53 [crusher] yvery good lorena.2 ipsilateral dosral column and CST and 1 ipsilateral spinothalamic .reason i said earlier

22:08:10 [acestep1] cst n dorsal- ipsilat n below the lesion n lat spinothalamic is ipsilat at teh level of teh lesion n contralat below the lesion

22:08:26 [Lorena] it is the Brown Sequard syndrome

22:08:39 [vladi] brown-sequard sy- ipsilateral motor paralysis, ipsilateral loss of tactile, vibration prorprioception, cointralateral pain- and temp loss and ipsilateral loss of all sensation at level of lesion

22:08:45 [crusher] fisrt 2 decussate later than T10 and 3 decussate early in spinal cord

22:08:59 [acestep1] spinothalamic i think cuz of decussation will b lost bilat at the level of teh lesion

22:09:35 [acestep1] but am not thinking straight am v sleepy right now

22:10:01 [Step_1] a couple more questions than we will move to gross

22:10:04 [acestep1] crsuher u mean 5 tracts ? can u name them plz

22:10:05 [Step_1] which CN produces diplopia and eye pointed nasal...also medical strabismus?

22:10:34 [acestep1] 6 th nerve

22:10:52 [crusher] brown sequard is due to lateral rectus effected so abducent

22:10:59 [Lorena] why isnt ataxia present even if the dorsal spinocerebellar tract was also affected, in the same syndrome (brown sequard)??

22:11:18 [Step_1] yes, 6th CN. good ace

22:11:20 [crusher] i,m sorry its lateral rectus effected so abducent

22:11:28 [acestep1] thnx

22:11:40 [acestep1] wow lorena gd q

22:12:04 [vladi] mneumonic LR6SO4R3- it's abducens

22:12:24 [Lorena] just to complete the syndrome which seems to be very HY

22:12:36 [Step_1] because the person can still see and has sensation with the other lower limb...is that right?

22:12:42 [acestep1] yes

22:13:00 [acestep1] gd 1 valadi

22:13:57 [Lorena] yes step 1

22:14:08 [acestep1] wow step1

22:14:39 [Lorena] and the muscles are weak for the affected corticospinal tract, so the ataxia is masked

22:15:02 [acestep1] hmm

22:15:16 [nne] i am the weakest link in neuro, so i'll try to follow

22:15:28 [Step_1] good point lorena

22:15:33 [vladi] what's Edinger-WESTFAL NUCLEUS RESPONSIBLE FOR

22:15:43 [acestep1]

22:15:47 [Step_1] thats ok, we need to move on to gross soon anyway

22:15:58 [crusher] very good lorena

22:16:15 [Step_1] 3rd cranial nerve, accommodation i think

22:16:22 [acestep1] consentual light reflex n accomodation reflex?

22:16:41 [crusher] pupulary lighr refelex

22:17:37 [acestep1] ya smae eye light + light refex as well

22:17:47 [acestep1] same eye imean

22:18:45 [crusher] lets come on conjugate gaze very very HY

22:19:26 [acestep1] k

22:19:42 [vladi] RIGHT- EWN PROJECTS TO CILIARY GANGLION NEURONS, WHICH SUPPLY THE CILIARY AND SPHICTER PUPILLAE MUSCLES, WHICH ARE NEEDE3D FOR ACCOMMODATION AND PUPILLARY CONSTRICTION, RESPECTIVELY, HY Q- THEY USUALLY PROVOKE TO ANSWER ABOUT CONVERGENCE

22:20:15 [Lorena] thanks vladi

22:20:48 [Step_1] if lesion is in left MLF, what will the symptoms be?

22:20:57 [acestep1] ok but this means direct n consentual light relfex both r + right ?

22:21:52 [acestep1] opthalmoplegia- nystagus,

22:22:30 [vladi] NJYSTAGMUS IN LEFT EYE AND ABDUCTION OF LEFT EYE, CONVERGENCE IS NORMAL

22:22:43 [Step_1] very good stuff and pics on this thread about visual field defects http://www.valuemd.com/viewtopic.php?t=9502

22:23:04 [acestep1] yes v rtue

22:23:13 [acestep1] v true imean

22:23:14 [crusher] when pat ask to look R .rt eye look cannot look R but left eye able to look rt where is the lesion

22:23:31 [Step_1] the ans is that the left eye cannot look right, convergence is intact

22:23:56 [acestep1] k

22:24:21 [Step_1] right abducens

22:24:30 [acestep1] yes

22:24:38 [acestep1] lat rectus

22:25:12 Lorena enters this room

22:25:25 [acestep1] wb lorena

22:25:30 [crusher] lesion is in rt abducent nerve.suppling the lateral rectus

22:25:43 [Step_1] what about pt asked to look right and neither eye can look right?

22:25:57 [Lorena] i got disconnected

22:26:06 [vladi] hi lorena

22:26:12 [acestep1] aww

22:26:20 [crusher] cos rt is unable to abduct while left eye is able to adduct,

22:26:24 [Lorena] lesion in cerebral cortex?

22:26:39 [crusher] abducent nucleus

22:27:00 [Step_1] it can be either right NUCLEUS or can also be left cerebral cortex....the difference is that the latter would have a slow drift to the left

22:27:37 [crusher] and also no sign of facial paralysis

22:27:39 [nne] that means left eye dosn't move with right eye in the same direction?

22:28:12 [vladi] lorena don't answer so fast- just get enrolled- it's typical point on real exam- we are all afraid run out of time

22:28:19 [Step_1] when looking to the right, they would both be stuck in the middle at furthest point

22:28:29 [crusher] while there will be sign of facial paralusis in abducent nucleus cos both 6 and 7 are close together

22:28:50 [Lorena] you are right vladi, thank you

22:29:03 [Step_1] thats true crusher

22:29:21 [acestep1] yes gd pt crusher

22:29:27 [Step_1] ready for some gross?

22:30:03 [acestep1] k

22:30:15 [acestep1] hey wht abt brainstem lesions

22:30:26 [vladi] yes

22:30:52 [crusher] yes ..there are few more hy points in neuro

22:31:21 [acestep1] yes

22:31:24 [Step_1] there is still some stuff left out in neuro, but we should at least cover a little of each subject in case ppl need to go. we can always go back if we have time. how about another 10 mins or so

22:31:47 [acestep1] k

22:31:51 [vladi] i noticed that many guys who recently passed mention that they got a lot of Q about nerve and blood suply of extremities

22:31:55 [acestep1] sure np

22:32:07 [acestep1] ic

22:32:26 [acestep1] didnt know tht

22:32:37 [vladi] what stand for ppl and np

22:32:42 [Step_1]>[vladi] thats actually gross....we'll talk about that

22:33:01 [Step_1] ppl= people and np=no problem

22:33:17 [acestep1] ya . sorry for the short hand

22:33:23 [Step_1] its internet slang

22:33:26 [acestep1]

22:33:35 [Lorena]

22:33:39 [acestep1] ya

22:33:47 [Step_1] ok, some brainstem lesions?

22:34:01 [acestep1] k

22:35:07 [Step_1] contra spastic hemiparalysis of body, contra loss of position and vibration sense of body, tongue deviates to lesion side....where is lesion?

22:35:15 [nne] okay, you guys should carry me along

22:35:31 [Lorena] i have to go to prepare lahmajoon guys, i'll see you next chat

22:35:56 [Lorena] have an excellent memorial weekend and thanks a lot for today's chat

22:35:57 [vladi] in brain stem

22:35:58 [acestep1] medial meduallary synd ?

22:35:59 [Step_1] ok lorena....have a nice memorial day

22:36:35 [Lorena] bye

22:36:37 [acestep1] ya . take care lorena

22:36:46 [nne] bye lorena

22:36:48 [acestep1] byeeeeeee

22:37:16 [nne] Step 1 what is the answer

22:37:33 [Step_1] the best way to tackle this is to first go for the CN (cranial nerve lesion) because they are ALWAYS ipsilateral. this will tell you which side the lesion is on. in this case the tongue deviates to the lesion side because of CN 12. where is cranial N 12...medial or lat?

22:37:56 [acestep1] medial

22:38:32 [Step_1] its located medially. and what level?

22:38:45 [Step_1] medulla, pons, etc?

22:38:47 [acestep1] upper medulla i think

22:39:14 [Step_1] thats right.

22:39:17 [vladi] medial-3,6,12

22:39:43 [Step_1] so that will let you know that it is medial medulla. you can use the others signs to confirm.

22:40:01 [acestep1] yes

22:40:09 [vladi] posterior cranial fossa

22:40:12 [nne] where can i read this info from?

22:40:22 [Step_1]>[vladi] you forgot about 4

22:40:39 [Step_1] it is in kap lan neuro notes

22:40:40 [acestep1] caplan

22:41:06 [Step_1] lets try another

22:41:20 [acestep1] k

22:41:40 [vladi] in <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>FA</a> they mention 3,6,12

22:42:17 bisma enters this room

22:42:33 [Step_1] in kap lan they also mention 4. its probably not mentioned there because it is in the back rather than the front with the others

22:43:08 [Step_1] contralat spastic hemiparesis of body, contralat loss of position and vibration, medial strabismus....where is the lesion?

22:43:34 [Step_1] which is the CN lesion is the first question you should ask to solve this

22:43:46 [vladi] actually IV arises dorsally closer to CNV

22:43:51 [Step_1] what gives medial strabismus?

22:44:07 roshy04 enters this room

22:44:16 [acestep1] 6 th nerve

22:44:23 [crusher] stabismus means 4th nerve ,,medial pointine synd

22:44:30 [acestep1] lesion

22:45:12 [crusher] if 6th nerve then medial pontine synd

22:45:18 [Step_1] strabismus medially means the 6th nerve

22:46:09 [Step_1] remember di[plopia, eye nasally pointed and medial strabismus is the 6th

22:46:33 [Step_1] where is the 6th located? medial or lateral?

22:46:38 [vladi] VI- middle cranial fossa at superior orbital fissure, that why probably it's medial inferior pontine sy

22:46:43 [acestep1] medial

22:47:03 [crusher] medial on pons

22:47:12 [Step_1] yes medial. and at what level?

22:47:36 [Step_1] yes correct crusher....i'm just taking it in steps so that they can learn how to tackle them

22:48:13 [Step_1] its medial pons

22:48:26 [vladi] usually it's result of occlusion of the paramedian branches of basilar artery

22:48:50 [Step_1] the key is to learn where the CNs are located and what deficits they cause....thats right vladi

22:49:20 [Step_1] if it was the lateral pons instead, what would be the signs?

22:49:53 [Step_1] first ask your self what CNs are located in the lat pons?

22:49:58 [crusher] for fasial and 8th nerve lesion sign

22:50:10 [vladi] all right-thanks step1 for excellent alghoritm of action

22:50:28 [crusher] like fasial paralysis,,n hearing problem

22:51:11 [Step_1] yes crusher. it would affect the 5th, 7th and 8th nerves (learn these deficits) plus any tracts that go travel laterally

22:52:01 [Step_1] does that make sense?

22:52:33 [acestep1] yes

22:52:42 [acestep1]

22:52:57 [crusher] definetly step1

22:53:07 [Step_1] here is a question and pic about it for later http://www.valuemd.com/viewtopic.php?t=9711

22:53:16 [vladi] lateral inferior pontine sy- facial nucleus, intraxial nerve fibers involved, cophlear nuclei and intraxial nerve fibers, spinal trigenimal nucleus, middle and inferior cerebellar pedunclules, spinal lemniscus and descendinhg symp tract

22:54:31 [Step_1] good stuff vladi.

22:54:49 [acestep1] ok 1 more point tht i wanted 2 mention is a nerve is lesioned things opp to its action would happen eg 6 nerve is for lat rectus when its lesioned the eye can no longer go 2 the lat side n the healthy medial recutus would instead pull the eye medially

22:55:30 [Step_1] good point

22:55:43 [acestep1] thnx

22:55:58 [vladi] how about Parinad, Benedict and Webers sys

22:56:33 [acestep1] yes gd q valadi

22:56:54 [Step_1] Webers I remember because the W has three lines that look like III which means its the 3rd CN

22:57:18 [acestep1] hehe

22:57:19 [Step_1] where is the 3rd CN? medial or lat?

22:57:27 [acestep1] gd 1 step1

22:57:36 [vladi] all- midbrain

22:57:37 [Step_1] and at what level?

22:57:38 [acestep1] medial i think

22:57:52 [acestep1] midbrain

22:58:16 [crusher] medial

22:58:21 [Step_1] medial and at the level of the midbrain....also known as ventral midbrain syndrome

22:58:40 [Step_1] can be caused by occlusion of the PCA

22:58:41 [vladi] rostral midbrain

22:59:07 [acestep1] k

22:59:14 [acestep1] thnx

22:59:14 [vladi] weber is medial midbrain

23:00:06 [vladi] what's else comprise weber

23:00:25 [Step_1] webber is medial and ventral (front and middle)

23:00:36 [Step_1] so you will see CN 3 deficits ipsilaterally like dialted pupil, ptosis, ete points down and out

23:01:33 [Step_1] also cortico spinal tract and CST affected. both long tracts so they will be contralat or opposite the side of the CN deficits

23:01:57 [vladi] contralateral spastic hemiparesis (cortsospinal trct), contralateraql weakness of lower face (VII), tongue (XII) and palate (X)

23:02:01 [Step_1] sorry i meant corticobulbar also

23:03:19 [Step_1] medial medullary syndrome i think

23:04:12 [vladi] i disagree step1- weber is middle and dorsal (posterior)- see HY Neuroanatomy Lippincott

23:04:14 [Step_1] no cant be med medullary.

23:04:25 [crusher] medialmedulla and lateral pons are involve

23:05:17 [crusher] and s[pinal % nuclues involve

23:05:25 [Step_1] webers i have as ventral midrain syndrome according to kap lan

23:05:26 [acestep1] i think whole medualla

23:05:31 [vladi] sorry- you right, it's actually anterior i,e, ventral

23:06:03 [acestep1] ya all nerves except 4 nerve r anterior

23:06:15 [acestep1] i better get seom coffee

23:06:19 [acestep1] brb

23:06:32 [Step_1] and we still havent done gross

23:06:59 [acestep1] hey step1 lsietn y not keep gross for next time

23:07:14 [acestep1] cuz neuro is so hy

23:07:21 [Step_1] because we have a schedule to keep

23:07:29 [acestep1] plzzzzzzz

23:07:35 [acestep1] k

23:07:40 [acestep1] np

23:07:51 [crusher] lets do some gross otherwise neuro will never end

23:08:01 [acestep1] lol

23:08:06 [acestep1] k

23:08:20 [crusher] ace step1 ..see there is already schedulae n ppl r preparing for it

23:08:28 [vladi] let. move on- don't relax acestep1

23:08:45 [acestep1] yes

23:08:55 [acestep1]

23:09:08 [Step_1] we can never go over everything during the chat, but we can use the forum to ask and answer questions in between

23:09:29 [acestep1] yes i agree

23:09:37 [Step_1] ok, ready for some gross?

23:09:47 [acestep1] sure

23:09:50 [crusher] yep

23:10:10 [Step_1] where are the heart valve sound locations best heard?

23:10:15 nne enters this room

23:10:28 [vladi] brachial plexus- very HY-Klampke paralysis- what's brach of branch.plexus

23:10:40 [crusher] aortic rt 2nd intercostal

23:11:26 [nne] Pulmonry - 2nd left intercoasta

23:11:30 [crusher] pulm left 2nd intercostal

23:12:17 [acestep1] hmm sorta n pulmonary 2 space tricuspid just at teh lft sternal border n mitarl at 5

23:12:28 [crusher] tricuspid l4th eft sternal border

23:12:37 [Step_1] http://www.valuemd.com/viewtopic.php?t=8837 is the thread with question and pic of heard sounds. mneumonic is APT M as in apartment M. it is 2nd and 5th intercostal with Aortic on right 2nd, Pulm on left 2nd, Tricusp on =sternal border of 5th and Mitral on left 5th

23:13:33 [acestep1] so except aorta everything on lft

23:13:55 [acestep1] teh valves tht rpod 2 hrt sound r in 2nd space

23:14:09 [Step_1] yep and tricuspid is on the sternal border of left while the Mitral if further left

23:14:15 [acestep1] n those which prod 1 st heart sound r in 5 th

23:14:24 [acestep1] yes

23:14:33 [acestep1] er midclavicular line

23:14:36 [Step_1] good point ace

23:14:41 [acestep1] ?????

23:14:52 [acestep1] thnx

23:15:42 [Step_1] fracture of surgical neck affects which what? what signs?

23:16:08 [crusher] axillary nerve

23:16:19 [acestep1] hey step1 am i right is it mid clavicular line

23:16:36 [crusher] ARM=neck,shaft,epicondyl

23:16:42 [Step_1] yes axillary...dont worry about that sign, not very high yield

23:16:50 [acestep1] k

23:17:10 [Step_1] yes, midclavicular line is term often used

23:17:22 [acestep1] k thnx

23:17:54 [acestep1] ok neck - radial

23:17:55 [nne] crusher is that a mnemonic

23:18:14 [acestep1] sorry

23:18:22 [crusher] which trunk is injured with person showing claw hand,tell root value also

23:18:30 [Step_1] good mneuomonic crusher. so thats ARM meaning Axillary, Radial, and what?

23:18:35 [acestep1] allry neck , midshaft - radial , n last si ulnar

23:18:41 [Step_1] median

23:19:01 [nne] od one

23:19:06 [crusher] ARM=axillary,radial,musculocutaneous=neck,shaft,ep icondylar damage

23:19:07 [acestep1] oh i thought medan was supracondylar

23:19:15 [nne] i mean good ne

23:19:38 [Step_1] good one

23:19:54 [Step_1] which one gives wrist drop?

23:19:55 [crusher] its in <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>FA</a>.

23:20:15 [crusher] radial

23:20:38 [acestep1] thxn crusher will check it out

23:20:47 [Step_1] yes....wrist drop is radial

23:20:55 [acestep1] yaagree

23:20:57 [crusher] which trunk is injured with person showing claw hand,tell root value also

23:21:21 [vladi] other mneumonic DR CUMA: wrist Drop-Radialis, Claw hand- Ulnaris, Median- Ape hand

23:21:42 [Step_1] claw hand is from the ulnar nerve

23:22:01 [acestep1] gd 1 vladi

23:22:17 [acestep1] c8, t1

23:22:18 [Step_1] that great vladi!

23:22:39 [vladi] low trunk

23:22:44 [Step_1] i agree c8 and t1

23:22:47 [crusher] very good step1..its klumpkees paralysis

23:23:35 [acestep1] yes

23:23:38 [Step_1] but in c8 and t1 you will also affect the median nerve so you will also see ape hand

23:23:42 [acestep1]

23:24:01 [acestep1] yes agree

23:24:11 [Step_1] if just the nerve itself rather than the root it will be claw hand alone

23:24:27 [vladi] exactly that i sked for a while, how about Erbe

23:24:30 [acestep1] yes

23:25:07 [crusher] a 1 week old comes with his rt arm doesnot move ,delivery was breech.arm extended internally rotated adducted and pronated forearm.whats damage n nerve root value

23:25:24 [Step_1] erbs paralysis will give waiters tip where forarm is extended and protonated like a waiter asking for a tip

23:25:30 [acestep1] sam lost - supraspacular, axillary , musculocutaneus

23:25:47 [nne] c5, 6

23:25:51 [Step_1] c8 and t1

23:25:56 [acestep1] i think thts erbs

23:26:05 [vladi] C5-6

23:26:17 [crusher] yes.erb paralysis waiters tip.upper plexuses=c5/c6

23:26:20 [acestep1] agree

23:26:31 [acestep1] yes :0

23:26:40 [acestep1] oops imean

23:26:53 [acestep1] yes so vladis q is ans as well

23:26:54 [Step_1] that was a real test question about the breech delievery...so what is the answer

23:27:07 [acestep1] oh wow

23:27:12 [crusher] diff b/w erb and klumpkees is earlier lower trunk c8/T1 and later upper trunk C56

23:28:12 [crusher] i,m sorry i wrote the other way,looks i,m sleepy

23:28:17 [vladi] which muscle initiate abduction

23:28:46 [crusher] erbs ===upper trunk=C56, and klumpke lower trunk=C8 T1

23:28:50 [acestep1] np

23:29:05 [acestep1] not sure seraatus ant

23:29:14 [Step_1] yes, but which one will be caused by breech delivery?

23:29:16 [crusher] pect major

23:29:34 [crusher] erbs paralysis

23:29:36 [nne] ebs palsy

23:29:43 [acestep1] erbs step1

23:29:55 [Step_1] thanks

23:30:04 [vladi] that;s right crush-no doubts

23:30:21 [acestep1] ic

23:30:36 [acestep1] wht abt the other 2 muscles

23:30:48 [vladi] suprasinatum

23:30:55 [acestep1] deltoid is for upto 90

23:31:00 [acestep1] ok

23:31:08 [acestep1] till wht ?

23:31:19 [acestep1] n wht abt overhead abduction

23:31:26 [crusher] deltoid and serratus anterior

23:31:42 [acestep1] k thnx

23:31:51 [vladi] suprasinatum only for first 15 degree, then- deltoid etc

23:32:07 [acestep1] k thnx vladi

23:32:26 [crusher] serratus ant innervated by long thoracis nerve ,so if injured no abduction above 90%

23:33:00 [Step_1] which nerve will cause "winged scapula" if damaged?

23:33:01 [acestep1] k

23:33:28 [crusher] long thorasic

23:33:28 [acestep1] long thoracic - c5, c6 , c7

23:33:42 [vladi] good point, crush

23:34:05 [Step_1] long thoracic (serratus anterior) is correct and from C5, 6 and 7

23:34:22 [vladi] thoracis longus

23:34:42 [crusher] A person working very late with comp.find dec sensation on first three digit and half 4th and on threnaar eminance,which nerve damage

23:35:22 [vladi] i did get you step1- is it same thor.longus and serratus

23:35:29 [Step_1] median nerve probably from carpal tunnel

23:35:49 [acestep1] agree with step 1

23:36:03 [Step_1] the long thoracic nerve affects the serratus anterior muscle

23:36:14 [Step_1] causes winged scapula

23:36:23 [vladi] median

23:36:24 [crusher] very good .its carpal tunnel and by median nerve damage,immediate decompression is Tx

23:36:40 [acestep1] k

23:37:08 [vladi] i got your point, thanks

23:37:11 [acestep1] brb

23:37:52 [vladi] crush- you mean surgical decomporession

23:38:07 [crusher] yes vladi

23:38:22 [Step_1] football player gets strong blow to the lateral knee when foot is fixed. what is probably damaged?

23:39:08 [acestep1] common peroneal

23:39:26 [vladi] actually from knowledge they operate very rarely when all conservative approaches are ineffective

23:40:20 [acestep1] ic

23:40:29 [Step_1] the unhappy triad includes the medial collateral ligament, the medial meniscus and the anterior cruciate ligament. these are often damaged in athletes from lateral contact of knee. very HY!

23:40:31 [vladi] and later.collataral lig.

23:41:05 [Step_1] lat collateral is usually not affected in this type of injury

23:41:24 [acestep1] sorry im alil sleepy

23:41:42 [acestep1] raelly sorry abt tht

23:42:02 [crusher] its ok ace step1

23:42:04 [acestep1] yes all the supporting ligaments n menisci r ruptured

23:42:08 [vladi] i know but i asked about hit to lateral surface of knee

23:42:24 [acestep1] no actually ist way past my bed time

23:42:32 [Step_1] if the injury were on the opposite side pushing the knee from medial to lateral (less common) than the lateral collateral would be damaged

23:42:34 [acestep1] hehe

23:42:42 [crusher] foot drop in common peronel n dam

23:42:42 [vladi] good night, ace

23:43:03 [acestep1] nono im here

23:43:15 [acestep1] till we r done

23:43:38 [Step_1] i'm gonna go at midnight....we can cover alot in that time i hope

23:43:41 [acestep1] yes agree with both crusher n step1

23:43:52 [acestep1] k

23:43:57 [acestep1] sure

23:43:59 [crusher] sure ,,me too.

23:44:04 [acestep1]

23:44:10 [vladi] i got you- of course, unhappy triad- most HY Q, I'VE BEEN CONFUSED WITH YOUR STEMQ

23:44:20 [crusher] guys keep asking Q

23:44:41 [Step_1] sorry, i should have been more clear

23:44:55 [vladi] all right let's finish- good night everybody

23:45:00 [Step_1] the other HY with these is the Ant vs post cruciate

23:45:07 [acestep1] ok u knwo abt sat night palsy another name for radial nerve inj

23:45:13 [acestep1] k

23:45:13 [crusher] goodnight vladi

23:45:37 [acestep1] hey step1 u were clear dont worry

23:45:46 [acestep1] hey si vladi leaving

23:45:47 [Step_1] good night vladi

23:45:58 [acestep1] ??

23:46:07 [acestep1] gn vladi

23:46:26 [acestep1] oops let me get teh caffiene kick

23:46:39 [vladi] no- if somebody stay, me to0- i've heard about posterior cruciatum

23:47:19 [Step_1] the drawer sign is used to test for damage of the cruciates. with knee flexed the movement of leg anteriorly will be which ligament? what about post movement?

23:47:33 [acestep1] k

23:47:50 [acestep1] ant - ant cruciate if im nto wrong

23:47:59 [acestep1] not wrong imean

23:48:15 [Step_1] here is the thread with pic, quest and explan for PCL http://www.valuemd.com/viewtopic.php?t=9464.

23:48:33 [acestep1] k

23:48:40 [Step_1] yes ant movement is ant cruciate and post movement is post cruciate....easy one to remember

23:48:44 [acestep1] thnx

23:48:51 [crusher] a young girl get intense pain in her right collar bone.also notice a prominent ,she tripped over n fell down on outstrech hand Dx what damage

23:48:55 [vladi] anterior- ant.cruciate and respectively post

23:49:01 [acestep1] yes

23:49:02 [Step_1] that question was one a couple of real exams

23:49:54 [acestep1] radial

23:49:54 [Step_1] also noticed a prominent what?

23:50:01 [acestep1] ic

23:50:26 [acestep1] but in erbs u also have hyperext of teh head

23:50:33 yamini enters this room

23:50:52 [Step_1] hi yamini

23:51:09 [crusher] promince where oter n middle 2 rd of clavicle meet

23:51:13 [acestep1] hi yamini

23:51:19 [yamini] hi step_1&everybody

23:51:32 [vladi] hi yamini

23:51:37 [crusher] hi yamani

23:51:41 [acestep1] hey

23:51:57 [acestep1]

23:52:01 [crusher] ans is clavicular fracture

23:52:18 [yamini] hi vladi,acestep1,crusher

23:52:34 [Step_1] i wouldnt have gotten that one...tnx crush.

23:52:40 [acestep1] hey welcome

23:52:45 [Step_1] hi yamini....good to see you

23:52:55 [acestep1] hehe . me neither

23:53:21 [acestep1] but i think tht prominence is the indication

23:53:23 [Step_1] what landmark distinguishes direct from indirect inguinal hernia?

23:53:43 [acestep1] inf epigastric arteries

23:54:22 [acestep1] medial to indirect n last 2 direct

23:54:23 [Step_1] also a real question. the ans is the inf epigastric art...good job. which one passes medial and which one lateral to the inf epi art?

23:54:35 [acestep1] thnx

23:54:39 [crusher] 6 yr male reffered to orthopedics surgeon with recent limp.,complain right griuon ,with radiation to right grion .o\on x,*** small femoral head epiphysis DX

23:54:53 [acestep1] wow

23:54:59 [crusher] epigastric art. MD dont Lie

23:55:23 [Step_1] good. thats righ

23:55:45 [Step_1] medial is direct and lat is indirect

23:55:51 [vladi] lege-pertis sy

23:56:11 [crusher] very good vladi

23:56:15 [acestep1] agree with vladi

23:56:28 [crusher] its legs calve perthesis.

23:56:39 [acestep1] ic

23:56:54 [acestep1] yes unilat n idiopathic i think

23:56:55 [Step_1] please explain

23:57:00 [acestep1] mmon in whites

23:57:05 [crusher] its avascular necrosis of femoral head

23:57:09 [acestep1] m . common in whites

23:57:20 [crusher] n obese boy

23:57:29 [acestep1] oh ic

23:57:46 [Step_1] tnx

23:58:09 [Step_1] which nerve involved in footdrop?

23:58:27 [vladi] othe tricky HY trick of Boards - slipped femoral- what's main differenece with lege-pertis

23:58:39 [acestep1] common peroneal - step1

23:59:01 [acestep1] hey vladi dunno

23:59:39 [Step_1] i dont know either. and yes ace, common peroneal is correct

23:59:40 [acestep1] osetoporosis

23:59:45 [crusher] common perneal step1

23:59:54 [acestep1] ?

--------- The messages that have been sent today start below ---------

00:00:06 [acestep1] k . thnx step1

00:00:28 [Step_1] which nerve involved in trendelenberg gait?

00:00:41 [yamini] what is clubfoot?

00:00:46 [acestep1] superior gluteal

00:01:15 [acestep1] hey yaminiu talking abt potters ? cuz thts teh only 1 i know

00:01:35 [crusher] sup.g;luteal n

00:01:57 [vladi] why nobody answered my Q abot lege-pertia vs. slipped femoral

00:02:07 [yamini] clubfoot is talipes equino varus

00:02:22 [acestep1] we dont knwo the ans sweetie

00:02:28 [acestep1]

00:02:32 [crusher] tell us ans

00:02:45 [Step_1] yes sup gluteal which innervates the gluteus minimus

00:02:48 [acestep1] yes

00:03:06 [acestep1] k

00:03:10 [Step_1] i dont know the ans, please explain because i'm week on that topic

00:03:59 [Step_1] ok, a few more before we call it quits

00:04:12 [acestep1] k . sure

00:04:13 [vladi] the main difference- it's age- from 6 to 10 y.o.- lege-pertis, later- slipped femoral

00:04:21 [acestep1] ic

00:04:30 [acestep1] thnx vladi

00:04:35 [Step_1] tongue innervation for taste, general sensation, motor?

00:05:01 [Step_1] thanks vladi, i will need to read up on that because i dont know much about it

00:05:12 [acestep1] motor- 5 nerve both afferent n efferent

00:05:14 [crusher] general sen

00:05:39 [acestep1] gen - 5 th nerve sensory nuleus i think

00:06:22 [acestep1] taste - ant 2/3 7 th via chroda tympani n psot 1/3 is 9 nerve

00:06:40 [acestep1] hey vladi tht was a gd q where did u read it up from

00:06:42 [Step_1] ant 2/3 is 7 for taste and V3 for sensation. post 1/3 is 9 for taste and sensation. root (base) is 10 for both. motor is 12 for tongue

00:06:51 [Step_1] very good

00:07:21 [acestep1] thnx step1

00:07:49 [Step_1] what is the arterial supply to the forgut, midgut and hindgut?

00:08:17 [crusher] thx step1

00:08:50 [vladi] tankhs- it's getting cllear bz in different sources- different stuff

00:09:05 [acestep1] ok

00:09:34 [acestep1] ok forgut- coeliac , midgut- sup mesenteric n hind gut - inf mesenteric

00:09:37 [yamini] coeliac trunk,SMA,IMA i think

00:10:12 [Step_1] forgut derviates are supplied by celiac art, midgut by sup mesenteric, and inf mesenteric for hindgut (need to know the stuctures of these areas). very good ace and yamini!

00:10:16 [vladi] forgut-truncus, midgut-SMA, hindgut-IMA

00:11:12 [acestep1] thanks

00:11:28 [Step_1] ok, i think we covered alot today.....probably time to call it a night....or day for some

00:11:28 [acestep1] see caffiene kick is working. hehe

00:11:46 [acestep1] sure np

00:11:52 [acestep1]

00:12:04 [acestep1] hey so next tiem biochem ?

00:12:15 [Step_1] now ace is on caffiene and wont be able to sleep

00:12:18 [crusher] my weakest sub ...ahh

00:12:26 [acestep1] hehe

00:12:36 [acestep1] no np its my day time

00:12:45 [acestep1]

00:12:45 [crusher] goodbye everyone.

00:12:58 [acestep1] gd bye crusher

00:13:06 [acestep1]

00:13:14 [Step_1] yes, i am also week in biochem and its all week long. good night everyone. have a great memorial day and see you all on wed

00:13:32 [acestep1] hey im weak as well

00:13:41 [acestep1] same 2 u step1

00:13:49 [acestep1]

00:13:52 [Step_1] bye

00:13:54 [vladi] thanks for superlongest chat-it was great

00:13:59 [acestep1] take care all of u

00:13:59 [yamini] good night everybody