chat transcript - physiology part 1 (muscle, cardiac, endo)

[Anonymous]

20:56:04 [crusher] hi dsa

20:56:24 [dsa503] how are you today?

20:56:45 [crusher] i,m ok.what about you?

20:56:56 [dsa503] not bad

20:57:12 [crusher] what are todays topics?

20:57:52 [dsa503] physiology

20:58:27 [dsa503] I think cardi & gIT

20:58:43 Step_1 enters this room

20:58:44 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

20:59:06 [Step_1] hi dsa and crusher

20:59:13 Bayda enters this room

20:59:33 [Bayda] hi there

20:59:45 hutals enters this room

20:59:49 merjo13 enters this room

20:59:57 [Step_1] hi bayda

21:00:00 [dsa503] hi step1

21:00:06 [merjo13] Hi everyone

21:00:07 [crusher] yes i know but i mean topics on physiolo

21:00:12 [hutals] hi all

21:00:24 [dsa503] hello merjo, hutals & bayda

21:00:31 [Step_1] hi there merjo and hutals

21:00:31 [crusher] hi step1

21:00:39 [crusher] hi everyone

21:00:55 Lorena enters this room

21:00:59 [Step_1] the topics on physio today are supposed to be muscle, cardiac and endo

21:01:05 [Step_1] i think

21:01:07 [crusher] hi lorena

21:01:07 period1 enters this room

21:01:07 [merjo13] Hi step1 ,dsa

21:01:18 [Step_1] hey lorena

21:01:18 [Lorena] hi everybody!!

21:01:18 [dsa503] hello lorena

21:01:24 [Lorena]

21:02:09 [Step_1] i have to confess, i didnt get through nearly as much as i wanted to in my physio studying, so i might stay a little quiet today

21:02:21 [merjo13] Wow there is 4 dyed hair this time...on the right side

21:02:32 zeda enters this room

21:02:48 [Lorena] yes, last chat we learnt how to dye our hair!

21:03:09 [zeda] hello everybody

21:03:20 [Step_1] hi zeda

21:03:24 [Lorena] hi zeda

21:03:33 [zeda] hi

21:03:37 [dsa503] hi zeda

21:03:41 [merjo13] Hi zeda

21:04:08 [Step_1] i posted a bunch of physio questions in the forum if anyone hasn't already taken a look

21:04:09 [Lorena] do you guys want to start now , it is a lot to review

21:04:36 [merjo13] Yep we better get started

21:04:37 [Lorena] thank you step 1, i will read them later , great job

21:04:59 [Step_1] lorena, please lead tonight because i didn't get much studying done on the subject....i'll jump in when i can

21:05:06 [dsa503] thanks step1, were there any explanations I found some of them difficult

21:05:06 [merjo13] Thanks Step1

21:05:31 [zeda] I am a beginner

21:05:35 [Lorena] me??

21:05:46 [zeda] st want to see how much i can solve Qs

21:05:48 [Step_1] those particular questions didnt have explanations. i will try to post some material about though if i can find some

21:05:57 [period1] hi every body

21:06:05 [Lorena] ok, i'll give my questions ....

21:06:07 [zeda] hi period

21:06:13 [period1] i am new to this forum

21:06:18 [Step_1] hi period. zeda, dont worry, we're all here to help each other

21:06:29 [dsa503] thanks step1

21:06:31 [merjo13] Hi Period

21:06:32 [zeda] me too

21:06:36 [Step_1] your welcome

21:06:44 [period1] so please dont mind,i will just watch

21:06:53 [period1] thanks

21:07:12 [Step_1] no prob, jump in whenever you want or just sit by and learn

21:07:17 [Step_1]

21:07:22 [dsa503] hi period

21:07:25 [Lorena] i only have questions about cardiac physio and endocrinology

21:07:27 [period1] please also let me know if u r having any good materials to share

21:07:59 [Lorena] if somebody wants to ask about muscle, bring it on

21:08:01 [Step_1]>[period1] have you taken a look in the download area yet?

21:08:19 [crusher] 57 yesar old alcoholic with abnormal mental satatus and serum glucose is 5omg/dl ,what is MOA of hypoglycemia

21:08:29 [period1] i tried but i am not able to open it

21:08:37 [zeda] is there something imp. in initial chapters ?

21:08:49 [zeda] am talking about K AP notes

21:09:17 [Lorena] i think you shoukd read those to be able to understand the rest of chapters in cardiac, renal, etc

21:09:28 [Bayda] what's MOA?

21:09:32 [zeda] thanks lorena

21:09:46 [Lorena] if you read them and understabnd them very well , the rest of chapters will seem easier

21:10:08 [Bayda] alchoholic - chronic pancreatitis - hypoglycemia?

21:10:13 [Step_1] moa = mechanism of action

21:10:33 [Lorena] welcome zeda

21:10:47 [Step_1] bayda, you might want to pick a brighter color from the rainbow on the right so we can see you text better

21:11:00 [dsa503] bayda can you change your colour pls, difficult to see

21:11:25 [Bayda] OK

21:11:35 [Bayda] test

21:11:42 [Bayda] sorry

21:11:44 [dsa503] yeah thats much better

21:12:08 [Step_1]>[crusher] ethanol met increases nadh/nad+ ratio in liver, causing diversion of pyruvate to lactate and OAA to malate, thereby inhibiting gluconeogenesis and leading to hypoglycemia

21:12:15 [Lorena] what is it crusher?

21:12:30 [period1] guys sorry to interrupt,but small question,have u all done with all the other subjects

21:12:32 [Step_1] no prob bayda...much better

21:12:34 [Step_1] thanks

21:12:44 [crusher] dec gluconeogenesis,alcohol...>acetaldehyde +nADH >>>ACETATE +nadh+ ..>ACETYL COA...High NADH/nah ratio shift the pyruvate to lactic acidosis ..So there will be dec pyruvate level available for gluconeogenesis....so hypoglycemia

21:12:54 [crusher] very good step1

21:13:18 [Step_1] no, there is a schedule posted on the calendar and in the step one forum. this week is physio. next chat on sat night

21:13:29 [Step_1] thanks crusher. good question.

21:13:38 kokushubila enters this room

21:13:48 [Lorena] what event starts isovolumetric contraction?

21:13:49 [Step_1] hi kokushubila

21:13:50 [period1] thanks step1

21:14:02 [kokushubila] Hello everybody!

21:14:19 [Lorena] hi kokush

21:14:20 [Step_1] mitral valve closure

21:14:30 [dsa503] closing of the atrioventricular valves

21:14:34 [merjo13] Mitral vave closue

21:14:36 [dsa503] hey koku

21:14:44 [kokushubila] Hi everybody!!!

21:14:49 [Lorena] very good step 1

21:15:12 [Lorena] merjo too and dsa

21:15:15 [Step_1] the pressure volume loop is extremely high yield!

21:15:38 [Lorena] can you explain what characterize ths stage? isovolumetric contraction?

21:16:08 [dsa503] there is an increase in pressure while the volume remains constant

21:16:51 [Step_1] period between mitral valve closure and aortic valve opening. period of highest oxygen consumption

21:17:11 [Lorena] yes dsa , both valves are closed (mitral and aortic)

21:17:37 [Lorena] veru good step1

21:17:41 [Step_1] when isolvolumic contraction starts, which heart sound is heard?

21:17:50 [Step_1] thanks lorena

21:18:02 [merjo13] S1

21:18:11 [zeda] what is STROKE WORK ?

21:18:11 [Step_1] cardiac is actually the only part i got through

21:18:13 [Lorena] s1

21:18:21 [kokushubila] S1

21:19:14 [Step_1] very good merjo, lorena, kokus. s1 is closing of the MV/TV in the beginning of isovol contract

21:20:02 [kokushubila] The work the heart performs on each beat,SW=Aortic pressure times stroke volume

21:20:10 [Lorena] remember to start always with the mitrral valve closure in the cardiac cycle

21:20:29 [merjo13] Thanks Lorena

21:20:33 [zeda] o STROKE WORK is equivalent to stroke volume, but it is normalized for differences in blood pressure. Thus it is a good indicator of heart performance.

21:20:34 [kokushubila] Sure Lor

21:20:56 [zeda] Stroke Work = (Stroke Volume) x (Mean Arterial Pressure)

21:21:22 [Lorena] what is the difference between stroke work and pressure work?

21:21:29 [Step_1] i didnt know that zeda....thanks

21:22:35 [kokushubila] Lets get back to Cardiac cycle where we started, is that ok?

21:23:03 [Lorena] yes, lets continue with cardiac cycle and go through it very well

21:23:26 [Step_1] sure, but what is the ans lorena?

21:24:23 [Lorena] i saw that somewhere but i dont remember where and i was hoping you knew, i will look for the answer ....i wrote the question but no answer (sorry)

21:25:05 [Step_1] what is the period of cardiac cycle called between aortic valve opening and closing?

21:25:31 [kokushubila] systolic ejection

21:25:36 [merjo13] Ejection phase

21:25:51 [Lorena] agree with kokush

21:25:55 [Lorena] and merjo

21:26:11 [Step_1] yes, systolic ejection or ejection phase....very good.

21:26:21 [kokushubila] And at what Pressure does the Systolic ejection start?

21:26:51 [kokushubila] Saw the Q today...

21:27:09 [Step_1] normally, between 80-100 i think

21:27:25 [dsa503] as soon as the pressure is equal to systemic pressure

21:27:35 [Lorena] at dyastolic pressure

21:28:04 [Lorena] at the end of dyastolic pressure is when the aortic valve opens and ejection phase starts

21:28:21 [kokushubila] Right, Step 1 normally at 80mmHg

21:28:35 Bayda enters this room

21:29:46 [zeda] conditions in which wide split of S2 is present ?

21:30:07 [Bayda] pulmonary hypertension?

21:30:14 [Step_1] asd

21:30:20 [zeda] ASD,PS,RBB,RV overload

21:30:22 [dsa503] asd

21:30:41 [zeda] and narrow split of S2?

21:30:51 [Lorena] good one zeda, thanks

21:30:53 [Step_1] normal

21:31:01 [zeda] LBB

21:31:35 [Step_1] what is lbb?

21:31:52 [Step_1] left bundle block?

21:32:58 [Step_1] zeda, what are the answers?

21:33:20 [zeda] left bundle branch

21:33:48 [Step_1] thanks

21:34:07 [Lorena] what are the best indices of preload?

21:34:07 [Step_1] when do you hear S3?

21:34:23 [zeda] split of S2 in ASD,PS,RBB,RV overload and split of S1 in LBB block

21:34:57 [zeda] S3 is normal in children and young adults

21:35:08 [dsa503] dilated ventricles

21:35:12 [Step_1] preload indices - left vent end diastolic vol and end diastolic pressure

21:35:15 crusher enters this room

21:35:34 [zeda] S3 usually reflects significant global ventr. dysfunction

21:35:37 [kokushubila] sorry Zeda is LBB in split of S1 or S2?Please explain

21:35:55 [Step_1]>[zeda] yes. what if you hear it in someone over 40, what would that mean

21:35:57 [Lorena] excellent step 1!

21:36:09 [crusher] sorry guys my net connection give me problems

21:36:16 [Step_1] thanks

21:36:16 neurodoctor_75 enters this room

21:36:26 [neurodoctor_75] hello room

21:36:27 [Step_1] hi neuro

21:36:41 [Step_1] no prob crusher....good to have you back

21:36:41 [zeda] d frequently asso. with ventri. dilatation and incr. lt. ventri. end diastolic vol. and press

21:36:44 [Lorena] hi neuro

21:36:47 [dsa503] hello neuro

21:37:18 [neurodoctor_75] hi!step 1,lorena,dsa503

21:37:30 [zeda] hi koku,split of S1 in LBB and split of S2 in RBB

21:37:45 [Lorena] i only know s3 and s4 are diastolic

21:37:51 [kokushubila] Thank you Zeda

21:37:53 [zeda] sorry

21:37:58 [zeda] S2 in LBB

21:38:07 [Step_1] s3 normal in children and young adults. if heard in someone over 40...abnormal probably due to blood entering a vol overloaded left or right ventricle. first cardiac sign of congestive heart failure.

21:38:25 [zeda] but it is narrow spli

21:38:37 [zeda] and S2 in RBB is wide spli

21:38:45 [neurodoctor_75] s3 is also in athletes?

21:38:57 [Lorena] thank you step

21:39:51 [Step_1] how to distinuguish between left and right ventricle overload when you hear a path S3?

21:39:53 [neurodoctor_75] plz correct me if im wrong step1

21:40:12 [kokushubila] Got u Z , thanks

21:40:12 [zeda] S3 can be present in MR,severe anemia or thyrotoxicosis

21:40:35 [zeda] you are welcome

21:40:53 [crusher] i think by by measurig thru pul cappliary wedge pressure

21:41:02 [Step_1]>[neurodoctor_75] i think thats right neuro because they have more efficient hearts, so they are overloaded normally

21:41:55 [zeda] what is atrial gallop?

21:42:02 [Lorena] the place of auscultation....where you hear it louder?

21:42:22 [Step_1] right s3 will increase on inspiration while left sided s3 will increase on expiration. the mneumonic is that the blood goes IN the right heart and out (EXits) the left heart.

21:43:04 yamini enters this room

21:43:26 [Lorena] hi yamini

21:43:27 [yamini] hi,everybody

21:43:29 [Step_1] yes crusher, i should have said how to distinguish with auscultation....sorry?

21:43:38 [dsa503] hi yamini

21:43:40 [Step_1] hi yamini

21:43:52 [zeda] hi yamini

21:44:03 [kokushubila] Hello Yamini

21:44:21 [Step_1] when do you hear an opening snap?

21:44:45 [yamini] MS

21:45:04 [crusher] mitral stenosis

21:45:23 [Lorena] mitras stenosis

21:45:38 [Lorena] followed by a diastolic rumble

21:45:43 [Step_1] opening Snap is heard with MV/TV Stenosis. think of the teen "snapping" to the music on MvTV. good job

21:45:49 [zeda] S3 best heard with the bell of the stetho. placed at the lt. ventricular apex with the pt. in the lt. lateral decubitus position

21:46:15 [crusher] blood try to pass thru the stenotic valve produces snap like sound

21:46:16 [zeda] what is atrial gallop sound?

21:47:38 [Step_1] The fourth heart sound, also called S4 gallop

21:48:01 [zeda] atrial gallop also called S4,frequently occurs in conditions asso. with decreased lt. ventri. compliance,or increased stiffness

21:48:21 [Step_1] you can hear it here if you want http://www.co.gaston.nc.us/gemshp/training/s4.htm

21:48:22 [zeda] right step1

21:49:37 [Step_1] what has a high pitched blowing sound?

21:50:06 Rahat3256 enters this room

21:50:31 [Rahat3256] hi everybody

21:50:33 [Lorena] hi rahat

21:50:36 sanya enters this room

21:50:43 [Step_1] hi rahat

21:50:43 [yamini] PSM

21:51:03 [yamini] HI rahat

21:51:09 [Rahat3256] just came to say that i cannot participate today

21:51:40 [Rahat3256] i have a little exam tomorrow , here in my country

21:51:40 [sanya] Hi everybody I'm new to this group!

21:51:42 [Lorena] stay

21:51:52 [Rahat3256] participate

21:51:56 [Lorena] welcome sanya

21:52:06 [Lorena] good luck in your exam rahat

21:52:07 [Rahat3256] i am very much greatful to you all

21:52:08 [sanya] Thankyou

21:52:08 [yamini] hello,sanya

21:52:14 [Step_1] i sanya. welcome

21:52:15 [Rahat3256] r mind

21:52:23 [Rahat3256] very much lorena

21:52:29 [Step_1] sorry you cant stay. good luck on your test

21:52:35 [Rahat3256] ok guys see you soon

21:52:35 [yamini] all the best rahat

21:52:42 [zeda] hi sanya

21:52:50 [Lorena] see you rahat

21:52:51 [Step_1] AV/PV regurg will have high pitched blowing murmur directly after s2

21:52:52 [kokushubila] Welcome Sanya

21:52:58 [Rahat3256] i will read the transcript

21:53:07 [Rahat3256] you yamini

21:53:16 [zeda] thanks step1

21:53:17 [Rahat3256] bye everybody

21:53:25 [Rahat3256] rena & step 1

21:53:26 [kokushubila] Good Luck to ur Exam

21:53:28 [Lorena] bye

21:53:35 [Rahat3256] thank you

21:53:48 [sanya] Thankyou everyone!

21:53:52 [zeda] good luck rahat

21:53:52 [Step_1] the av/pv regurg will also have widened pulse pressure

21:54:02 [Step_1] bye rahat

21:54:53 [Step_1] which is associated with edema? inc or dec cap pressure (Pc)?

21:55:17 [sanya] increased cap pressure

21:55:34 [kokushubila] Inc in Cap Pressues

21:55:40 [zeda] what causes murmurs?

21:55:48 [Step_1] inc Pc (cap pressure) is associated with edema. very good sanya, kokush

21:56:18 [yamini] turbulent blood flow

21:56:30 [sanya] turbulent blood flow thru' a narrow orifice

21:56:39 [zeda] high output,small or stenotic valve,regurgitant valve and flow through an inappropriate opening

21:57:11 [Lorena] murmurs are cause by inadequate opening or closure= turbulent flow

21:57:27 [zeda] yes

21:58:07 [Step_1] what percentage of children have innocent murmurs?

21:58:15 [zeda] name 3 imp. conditions in which pansystolic murmur present?

21:58:53 [yamini] MR,PS,TR

21:59:03 [sanya] VSD too

21:59:06 [zeda] AS,PS,VSD

21:59:44 [zeda] AS,PS,VSD HAS SYSTOLIC

21:59:53 [Lorena] where did you guys read all that?

22:00:13 [zeda] AND MR,TR,VSD have pansystolic

22:00:14 [Bayda] will PDA have systolic too?

22:00:39 [sanya] PDA has a continuos machinery murmur

22:00:42 [kokushubila] Murumurs =Inc Blood flow thru normal valve,where b flow is forced thru a narrowed valve orifice,regurgitation of blood thru an incomptent valve,blood flow thru an abnormal communication btn chambers of the heart eg VSD

22:01:06 [yamini] AS has ejection systolic murmur zeda

22:01:44 [zeda] yes yamini AS has systolic ejection murmur

22:01:52 [sanya] I thought PS also had ejection systolic murmur not pansystolic

22:02:05 [Lorena] what isthe asnwer to your question step1?

22:02:06 Marylandmed enters this room

22:02:22 [yamini] PS has PSM

22:02:25 [Step_1] hi maryland

22:02:42 [zeda] I wrote SYSTOLIC only,it should be systolic ejection murmur ( sorry)

22:02:44 [Step_1] 50% of normal children have innocent murmurs due to turbulent aretery blood flow in systole....this is normal.

22:03:06 [Lorena] thanx

22:03:11 [zeda] upto what age?

22:03:12 crusher enters this room

22:03:52 [Lorena] welcome back crusher

22:04:10 [zeda] innocent murmur present till what age?

22:04:19 [crusher] thank lorena..i ,m missing chat as my connection is not with me

22:04:58 [Step_1] “innocent” murmur which usually disappears by about four months of age.

22:05:08 [Step_1] notice the word usually

22:05:33 [Step_1] but i think that info is wrong if you have a better source

22:06:06 [zeda] thanks step1

22:06:28 [Step_1] i take that back, i'm finding that they can be heard much later in childhood too

22:06:37 [kokushubila] What other conditoins are gluteal/with innocent murmurs?

22:06:59 [zeda] Diastolic murmur is loudest in what condition ?

22:07:04 [kokushubila] ooops conditions associated

22:09:00 [Step_1] aortic insufficiency

22:09:03 [Lorena] where did you read all that about murmurs?

22:09:13 [zeda] In mitral Stenosis : during rapid filling in early diastole and then again during atrial systole in late diastole.

22:09:30 [Lorena] aortic insufficiency lasts longer, but is it also louder?

22:09:39 [zeda] This info. is in organ based K a p

22:09:52 [Step_1] that was just a guess on my part, i'm not sure

22:10:10 [Lorena] thank you zeda

22:10:34 [zeda] you are welcome

22:10:45 [kokushubila] Innocent murmurs are mostly seen in hyperdynamic state eg Pregnancy or anaemia

22:10:52 [Step_1] most of my murmur info is from the cardio section of goljan notes, but also kap lan has some stuff about it in physio (heart muscle mechanics section)

22:11:45 [zeda] are u talking about new Golj. book step1?

22:12:06 [sanya] goljan text book mentions that pul stenosis you get a ejection systolic murmur.

22:12:24 [Lorena] is it the same than is available for downloading step 1?

22:12:24 [Step_1] no, its his goljan path notes that were included with kap lan. about 500 pgs

22:12:45 [zeda] thanks step1

22:12:48 [Lorena] ic

22:12:51 [Step_1] no prob

22:12:58 [crusher] what type of murmur you will hear in tricuspid regurgitation and what area of heart

22:13:20 [zeda] pansystolic

22:13:35 [kokushubila] Pansystolic

22:13:36 [Lorena] systolic ejection murmur

22:13:39 [Step_1] pansystolic murmur

22:13:49 [merjo13] PSM

22:13:54 [sanya] pansystolic or holosystolic murmur

22:14:00 [Step_1] left sternal border aorund 5 ics

22:14:05 [merjo13] Sorry guys I was away for some time

22:14:10 [zeda] and best heard at the upper rt. sternal border with the pt. leaning forward with full expiration

22:14:15 [sanya] along the left sternal border

22:14:30 howto enters this room

22:14:38 [Step_1] hi howto

22:14:42 [zeda] upper rt. ( not lt.) sanya

22:14:53 [howto] hi

22:15:07 [Lorena] hi howto

22:15:15 [merjo13] Hi Howto

22:15:37 [howto] pathophys tonight guys?

22:15:50 [sanya] Thanks Zeda

22:15:51 [crusher] yes it is pansytolic and rt sternal border

22:15:52 [zeda] Crusher,plz. explain the ans

22:16:00 [zeda] thanks

22:16:26 [Step_1]>[howto] its physiology....cardiac, muscle and endo. the rest of physio is on sat night chat

22:16:55 [howto] k

22:17:16 [zeda] what is flow murmur?

22:17:55 [merjo13] Flow murmur are innocent murmurs due to hyperdynamic circulation

22:18:47 [crusher] which muscles soley dependent upon sarcoplasmic calcium......skeltal,smooth or cardiac?

22:19:01 [Step_1] for ausc, remember more or less around 2nd and 5th intercostal space. it goes APT M (as in apartment M) where A and P are on the level of 2nd ICS and T and M are on the 5th ICS....kinda like a Z. you gotta see a pic to appreciate this mneumonic

22:19:01 [zeda] present in what conditions?

22:19:11 [sanya] skeletal

22:19:31 [Lorena] pregnancy, hyperthiroidism,anemia

22:19:37 [merjo13] Anemia, hyperthyroidism,pregnancy, etc

22:19:49 [zeda] yes

22:20:28 [kokushubila] Thanx Merjo, Zeda

22:21:21 [howto] yah thanks guy

22:22:14 [kokushubila] What is Carey Coombs murmur?

22:22:15 [zeda] thanks step1

22:22:56 [Step_1] i was try to find the pic.....i'll post it on the forum later if you want to take a look

22:23:04 [Step_1] howto, you might want to select a brighter color from the rainbow on your right so we can see the text better

22:23:20 [Lorena] thanks step 1

22:23:24 [howto] k

22:23:41 [Step_1] your welcome

22:23:43 [Step_1] soft, short filling murmur due to vegetations on the mitral valve. It is usually heard in rheumatic fever

22:24:07 [merjo13] MDM

22:24:07 [howto] and it's mid-diastolic

22:24:18 [merjo13] Mid diastolic murmur

22:24:48 [kokushubila] Good!

22:25:02 [Lorena] effect of epinephrine on the heart?

22:25:02 [Step_1] anything else impt from cardio? if not we should move on to either muscle or endocrine

22:25:05 [kokushubila] Austin Flint murmur?

22:25:12 vladi enters this room

22:25:30 [sanya] seen in AR

22:25:41 [Lorena] hi vladi

22:25:55 [Step_1] hi vladi

22:26:07 [crusher] inc hr.EN

22:26:12 [yamini] AR

22:26:12 [vladi] hi everybody, sorry for being late

22:26:20 [Lorena] np

22:26:32 [crusher] hi vladi

22:26:59 [kokushubila] Yes Zeda ,Mid diastolic murmur heard at the apex in pt with AR

22:27:10 [sanya] epinephrine increases contractility and also increases HR

22:27:14 [Step_1] positive inotropic effect on the heart mediated by beta-1 receptors?

22:27:16 [kokushubila] hello Vlad

22:27:19 [zeda] thanks koku

22:27:41 [kokushubila] U r welcome

22:27:43 [yamini] Hi vladi

22:27:53 [Lorena] yes sanya and step, what about preload?

22:27:54 [vladi] how about Austi-Flint murmur

22:28:25 [Step_1] decrease preload i think because the contractility and HR is increased

22:28:38 [howto] yep

22:28:47 [Lorena] very good!!

22:28:49 [howto] decrease preload

22:29:01 Valentina1 enters this room

22:29:10 [sanya] It increase preload too because of the venoconstriction more blood contributes to the cardiac output.

22:29:10 [Lorena] preload and contractility go in opposite directions

22:29:18 [Step_1] An Austin Flint murmur is a mid-diastolic, low-pitched rumbling heard at the apex

22:29:46 [zeda] increase preload or decrease afterload has what effect on stroke volume?

22:29:50 adam enters this room

22:29:51 [vladi] hi valja

22:29:52 [howto] + inotropic drugs are used in

22:30:01 [crusher] bcos the Hr dec the filling rate of ventricle

22:30:10 [howto] ischemic cardiac pain

22:30:26 [Lorena] hi valentina, hi adam!

22:30:28 [crusher] cong heart failure

22:30:37 [zeda] thanks step1,Austin Flint murmur present in what conditions?

22:30:39 [adam] Hi, cool!

22:30:43 [vladi] good step1 what caused Austint-Flint

22:30:48 [sanya] increase preload or decrease afterload will increase stroke volume

22:30:56 [zeda] yes sanya

22:31:00 [adam] Cool, All the girls are dressed up today

22:31:02 [howto] by increase in contractility

22:31:09 [Step_1] aortic regurgitation

22:31:10 [howto] and decrease preload

22:31:17 [Lorena] lol

22:31:17 [Step_1] hi adam

22:31:29 [kokushubila] ha ha ha hi Adam

22:31:34 [dsa503] hello adam

22:31:36 [crusher] inc prelaod inc stroke vol and dec after load will dec stroke vol

22:31:38 [yamini] hi adam

22:31:42 [merjo13] Hi adam

22:31:44 [adam] HI every body!

22:32:02 [crusher] hi adam

22:32:12 [howto] hi

22:32:15 [howto] adam

22:32:22 [zeda] hey adam ,your girl is not here today?

22:32:34 [sanya] crusher if the afterload is decreased doesn't it increase SV

22:32:51 [adam] hummm, I checked her out already! probably I scared her last time,. lol

22:32:54 [Valentina1] I don't know how to dress up I look like a tomboy

22:33:03 sweta_chandra enters this room

22:33:07 [crusher] inc prelaod inc stroke vol and dec after load will dec stroke vol

22:33:08 [vladi] yes- this diastolic rumble is thought to result from the effect of the regurgitatant jet of blood on the anterior leaflet of the mitral valve

22:33:15 [Step_1] hi valentina

22:33:22 [Step_1] hi sweta

22:33:25 [adam] your okay Valentina, don't worry!

22:33:25 [zeda] bec. of u we lost her??

22:33:33 [sweta_chandra] hi guyes..

22:33:34 [vladi] hi adam

22:33:34 [kokushubila] Reminder: Do not forget to read/understand the calculations in CVS (simpel ones)they are HY !

22:33:36 [merjo13] Change the sex in your profile valentina

22:33:42 [Valentina1] I am not from Lesbos, I am a girl

22:33:54 [yamini] hi valentina,sweta

22:33:56 [adam] well, Zeda, come on! I begged her last time to say a word and she never paid attention ;(

22:34:02 [vladi] hi sweta

22:34:14 [adam] Hi Saweta

22:34:15 [sweta_chandra] hi there!

22:34:22 [dsa503] hi sweta

22:34:27 [zeda] hey adam,we were seriously studying till now!!

22:34:31 [Lorena] hi sweta

22:34:38 [zeda] now share your Qs

22:35:00 [Step_1] should we switch topics? what do you prefer, endo or muscle physiology?

22:35:08 [zeda] endo

22:35:11 [Lorena] endo

22:35:15 [sweta_chandra] endo.

22:35:26 [adam] okay, I am sorry! does this mean I screw things up when I show up?

22:35:39 [vladi] valja- don't take seriously these guys- i'm pretty positive in terms of your proper sexual orientation

22:35:52 [Lorena] adam, we are all happy to have you here with us

22:36:00 [kokushubila] Yes we shift as I said CALCULATIONS in CVS very HY

22:36:10 [merjo13] No there is always room for some lighter vein

22:36:10 [zeda] its ok adam,u r a good student

22:36:13 [adam] Thaks, go ahead guys, lets Rock!

22:36:16 [vladi] yes- you did, adam

22:36:18 Roxanita enters this room

22:36:33 [crusher] hi roxi

22:36:34 [Lorena] adam look who is here!!

22:36:45 [sweta_chandra] sorry guyes.. will see ya. emgency

22:36:47 [zeda] good luck adam,she is here

22:36:48 [adam] OKay, sorry Vladi!

22:36:48 [Step_1] ok kokush, maybe you can post some questions in the forum about that. or here if you want?

22:36:49 [zeda] i Rox

22:36:53 [adam] who Lorena?

22:36:57 [yamini] hi roxanita

22:37:07 [vladi] koku can you give some example for this calculations for training

22:37:09 [zeda] hi Rox

22:37:12 [adam] Hi Roxanita!

22:37:14 [kokushubila] Hi Rox , long time!

22:37:15 [Lorena] roxanita

22:37:22 [Lorena]

22:37:27 [adam] I am sure Vladi wanna kill me

22:37:31 [zeda] where were u Rox?

22:37:33 [Roxanita] Hi buddies

22:37:37 [zeda] we missed u

22:37:38 [crusher] hi roxi

22:37:43 [adam] Guys come on please, some body ask a Q

22:37:46 [Step_1] seeta, you have an emergency now you mean....i hope nothing serious

22:37:58 [Roxanita] I look like a guy now so don't fool me ok

22:38:07 [Step_1] hi rox....good to see ya

22:38:09 [vladi] hi Rox- we miss you

22:38:26 [Step_1] ok, lets move onto endo

22:38:37 [dsa503] hi rox

22:38:43 [Roxanita] Sorry, I have been doing other things

22:38:45 [adam] Rox, change the subject or Vladi is gonna kill me , please

22:38:52 [Roxanita] Hi Adam

22:38:55 [adam] move step 1

22:38:58 [crusher] what will be leval of PTH and ca in osteoporosis

22:39:01 [vladi] no- i don't please stay alive - we need you for a while

22:39:03 [zeda] ok

22:39:10 [crusher] hi roxi

22:39:17 [kokushubila] Starling equations,CO formulars etc .

22:39:17 [adam] Normal

22:39:48 [Roxanita] ok let's see what's going on

22:39:49 [adam] why does patient with hypothyroidism have hypercholestrolemia?

22:39:54 [kokushubila] Normal

22:39:56 [vladi] see adam, how generous can i be

22:40:08 [crusher] correct adam..it will be normal

22:40:14 [Roxanita] what have you done till now Lorenita?

22:40:16 [adam]

22:40:43 [adam] Lorenita and Roxanita and Adam without ita , lol!

22:40:44 [Lorena] because thyroid hormones accelerates choleterol clearance from the plasma

22:40:59 [crusher] level of PTH and Ca in malignancy

22:41:20 [zeda] what are hypothalamic releasing hormones?

22:41:20 [Roxanita] Lorena open you msn please

22:41:22 [adam] come on Loraneta, thyroid hormones are low in Hypothyroidism?

22:41:35 [sanya] Ca is increassed and PTH decreased in malignancy

22:41:38 [Lorena] i am surviving rox!

22:41:50 [adam] Ca hight, PTH .. normal

22:41:53 [adam] sorry low

22:42:03 [vladi] Ca increase, PTH decrease

22:42:04 [adam] Ca high, PTH llow

22:42:14 [crusher] correct sanya

22:43:10 [crusher] and in alpha 1 def

22:43:21 [vladi] HY Q- what else can cause severe hypercalciemia except tumors

22:43:27 [zeda] hypothalamic releasing hormones?

22:43:44 [adam] alpha 1 def: Ca low and PTH high

22:43:48 [crusher] sarcoidosis

22:43:53 [adam] Sarcoidosis Vladi

22:44:16 [Lorena] TRH, GHRH, CRH, samtostatin and PIF are the hypothalamic releasing hormones

22:44:20 [crusher] correct adam...low ca and high PTH

22:44:25 [vladi] great crusher, what else

22:44:31 [sanya] GHRH, GnRH, CRF, TRH, PIF are hypothalamic releasing hormones?

22:44:49 [adam] What is the effect of chronic Alcoholism on Ca and PTH level and how do you manage it?

22:44:50 [zeda] RIGHT SANYA

22:45:03 [crusher] TELL ME THE SECOND MESSENGER FOR prolactin.

22:45:30 [adam] Hey, Lorena and Roxanita! No side talks , Girls!

22:45:45 [Lorena] please one question at a time

22:45:49 [crusher] inc Ca and dec PTH .in chronic alcolohic

22:45:55 [adam] Prolactin 2nd messenger is Tyrosine kinase

22:46:16 [adam] what is GH second messanger?

22:46:57 [zeda] What are the major diseases associated with GH?

22:47:06 [adam] what is TSH , LH second messanger?

22:47:29 [merjo13] Gigantism ,Acromegaly

22:47:46 [zeda] pit. dwarfism,gigantism,acrmegaly

22:47:49 [Step_1] drarfism results from deficiency

22:47:53 [sanya] TSh & LH its cyclic AMP

22:47:57 [Lorena] laron dwarfism

22:48:00 [Lorena] too

22:48:09 [adam] no crusher this is not correct!

22:48:21 [crusher] ip3 for Gh

22:48:30 [Step_1] hypersecr will be gigantism and acromegaly, depending on age

22:48:32 [zeda] dwarfism results from insufficient secretion of GH

22:48:43 [adam] nope crusher

22:48:58 [Step_1] laron drawfism will have normal GH

22:49:01 [zeda] right step1

22:49:07 [kokushubila] Tyrosine kinase for GH?

22:49:08 [adam] How does somatotropic adenoma stain?

22:49:18 [Step_1] its the IGF-I that is decreased

22:49:21 [adam] correct Kok

22:49:35 [crusher] no in loran drawf Gh is normal but receptor defect

22:49:46 [zeda] Normal Growth requires normal levels of.?

22:50:05 [crusher] tyrosine kinase for IGF.

22:50:24 [adam] Thyroid H and GH

22:50:35 [zeda] Nutrition,GH,IGF-1,Thyroid hr.,Cortisol and Insulin

22:50:37 [Lorena] sorry, back

22:50:48 [sanya] Normal Growth requires normal levels of thyroid H, GH and androgens

22:51:13 [zeda] right sanya

22:52:04 [Step_1] GH is markedly reduced in jypothyroidism because thryroid hormones are required

22:52:07 [Lorena] how does aldosterone contribute in the acid base regulation by the kidney?

22:52:17 [adam] what is the difference between mechanism of action of PTU and Methimazole?

22:52:20 [zeda] What is the difference between Cushing's dis. and Cushing's syndrome?

22:52:53 [crusher] WOW LOT OF Q AT ONCE

22:53:07 [adam] Aldosterone causes H excretion in the LDC and collecting tubules and results in regeneration of new HCO3

22:53:13 [kokushubila] Can we start with Lor's Q ?

22:53:22 [zeda] yes

22:53:32 [Lorena] cushing disease pituitary origin, cushing syndrome is the constelation of symptoms

22:53:53 [Step_1] i agree with lorena

22:54:01 [adam] Cushing's disease when the source is Pitutiry, and syndrome when the cause is not Pitutiry

22:54:06 [Lorena] synonim of hypercortisolism

22:54:13 [crusher] aldo causes na reabsoption and k,and H secreytion.so causes high body ph.

22:54:36 [zeda] yes adam,C. syndrome has multiple causes..like what?

22:55:04 [sanya] Adam are the 2nd mess for LH & TSH cyclic AMP

22:55:30 [adam] exgogenous ( iatrogenic) is the most common one, ectopic is another, adrenal adenoam is another and adrenal hyperplasia is another

22:55:35 [vladi] cushind disease- mostly come from pituitary tumor )craniopharingeoma), cushing sy- pituary dependent bilateral adranel hyperplasia

22:55:39 [adam] yes Sanya

22:55:40 [zeda] adrenal cortical adenoma/carcinoma,ectopic ACTH production by non-pit. tumors,corticosteroid medications

22:56:59 [adam] what kind of receptor does AT II bind to and what is the second messanger?

22:57:17 [Lorena] aldosterone reabsorbs Na , lumen becomes more nagtive so it attracts K and H from the inside the cell facilitating H excretion into the distal tubule, whenever 1 H is secreted a HCO3 moves into the ECF

22:57:20 [adam] come on guys, you are not active enough today, wassup?

22:57:40 [zeda] thanks lorena

22:58:03 [crusher] ip3 is the 2nd mess of ANG2

22:58:09 [Step_1] i'm burnt from cardiac physio

22:58:16 [Lorena] i am getting dizzy with so many questions at the same time

22:59:02 [adam] No Lorena, Aldosterone definitely has an effect on the intercalated cells of the LDC and collecting duct where it increases H secretion resulting in the production of New HCO3, that is why we call it Regeneration

22:59:13 [zeda] what are the clinical manifestations of Cushing's syndrome?

22:59:55 [vladi] ip3 acts to increase Ca2+, diacylglycerol activates PKC

23:00:08 [adam] centripital obesity, depression, DM, hypertensions, stria and muscle waisting

23:00:32 [Lorena] agree with adam

23:00:35 [adam] how does stria form in cushings syndrome?

23:00:59 [zeda] Truncal obesity,moon facies,hypertension,osteoporosis,protein depletion,glucose tolerance,Ms. wasting and weakness.

23:01:10 [Lorena] thinning of the skin

23:01:15 [crusher] PTU inhibit coupling of thyroid hormone also dec peripheral conversion of T4 to t3.while methamizole ONLY INHIBIIT CONVERSION OF t4 to T3 safe in pregnancy

23:01:29 [Lorena] the stria, wide and purple are located in abdomen and hips

23:01:58 [adam] yes , lorena, why do they develop or what is the pathophysiology?

23:01:59 [zeda] yes lorena

23:02:12 [zeda] purple abdominal striae

23:02:13 [adam] nope crusher

23:02:26 [Lorena] adam, do you mean that besides the secondary effect i mentiones, aldosterona also has a direct mechanism to secrete H?

23:02:33 [zeda] also a clinical manifestation

23:03:44 [crusher] PTU inhibit coupling of thyroid hormone also dec peripheral conversion of T4 to t3.while methamizole ONLY INHIBIIT CONVERSION OF t4 to T3 safe in pregnancy

23:03:45 [vladi] what is main diagnotic marker to differentiate adrenal carcinoma from Cushing or ectopic ACTH sy

23:03:45 [adam] Methimazole and PTU bothe inhibit all the steps that involve the enzyme peroxidase. The advantage of PTU over methimazole is that PTU also inhibits the enzyme 5'-deiodinase which is responsible for the peripheral conversion of T4 to T3

23:04:15 [Step_1] thanks adam

23:04:40 [adam] High dose dexamethasoxe suppression test

23:04:51 [zeda] methods of measuring Hormone conc.?

23:05:12 [crusher] PTU inhibit coupling of thyroid hormone also dec peripheral conversion of T4 to t3.while methamizole ONLY INHIBIIT CONVERSION OF t4 to T3 safe in pregnancy

23:05:31 [adam] yes Lorena, definitely it has an effect on the intercalated cells

23:05:47 [Lorena] thank you

23:06:04 [crusher] sorry guys somehow my mress appear again

23:06:16 [adam] zeda, what is your question about , which Hormones ya mean?

23:06:24 Roxanita exits from this room

23:06:24 [zeda] how will u measure Thyroid hr. conc.?

23:06:28 [vladi] adam again they did not dig so deeply- i remember from my real exam just only 1 HY Q about PTU- it's final effect on peripheral conversion- that what we need to know

23:06:29 [adam] mress? what is that?

23:07:14 [zeda] RIA

23:07:23 [adam] Vladi, I am sorry! what else can I tell you> I will shut up and watch you guys

23:07:38 sweta_chandra enters this room

23:07:57 [Step_1] i dont think vladi meant it like that adam

23:08:14 [zeda] What are the actions of PTH?

23:08:27 [crusher] ip3 is the 2nd mess of ANG2

23:08:44 [Lorena] hey guys

23:08:56 [adam] I know but I donno what to say, i don't want to bring up questions that people would get upset because of them.

23:09:09 [adam] Hi Lorena, wassup?

23:09:11 [vladi] no- i really appreciate your input - but do not try to occupy your brain with some unneeded info, because our memory is not stretchable as we want

23:09:13 [Lorena] we are here to discuss , vladi didnt mean that

23:09:43 [Lorena] lets just continue , ok?

23:09:43 [zeda] don't be so upset adam

23:10:05 [adam] you could be right but I read this question from NMS book which is considered a HY book

23:10:17 [adam] okay guys, take it easy, I am not

23:10:22 [adam] keep going!

23:10:33 [Lorena] rapid action sof PTH inctrease ca absorption in kidney and decrease phosphate reabsorption

23:10:34 [zeda] for me i am beginner,i need to study more,so u are helping me

23:10:38 [Step_1] increase total T4 and normal TSH in 22 yo female. what test should be conducted next?

23:10:46 [zeda] by your discussions

23:10:48 [crusher] ip3 is the 2nd mess of ANG2

23:11:20 [kokushubila] Pregnancy test?

23:11:22 [crusher] ip3 is the 2nd mess of ANG2

23:11:23 [Step_1] i'm glad its helping zeda, we're all learning from each other

23:11:26 [Lorena] slow actions increase formation and activity of osteoclast and increase formation 1,25 diOH D

23:11:38 [vladi] sorry adam- i did mean anything wrong- i think that our joint point to figure out what' important stuff, what not- i try to match the real volume with other notes like Golijan etc and try to find with you guys what's really HY

23:11:50 [zeda] yes step 1 right

23:11:52 [Lorena] exactly , we are here to learn amnd make our studies more active , motivated

23:12:36 [zeda] so,what are the actions of PTH?

23:12:41 [kokushubila] Is it Pregnancy test Step 1?not sure !

23:12:52 [Step_1] yes kokush. preg -> inc estrogen -> incr TBG -> increase T$ (bound, not free). the free T4 will be normal

23:13:32 [adam] it's okay Vladi, I am the one who is sorry. let's keep going!

23:13:33 [zeda] thanks step1

23:13:58 [Step_1] good job. that was a real question and very high yield. what effect would androgens have on T4 and TSH?

23:14:15 [Lorena] i wrote the actions of PTH zeda...can you see them?

23:14:20 sweta_chandra enters this room

23:14:44 [adam] crusher, AT II binds to a Gq receptor which activate phospholipase C which in turn increases intracellular DAG and IP3. IP3 increases Ca+ release from the smoothe ER.

23:14:49 Roxanita enters this room

23:15:07 [Step_1] androgens would do the opposite of the estrogen. that is it would decrease synthesis of TBG -> dec total T4 with normal TSH.

23:15:10 [zeda] sorry lor.,now i can see

23:15:11 [adam] WB, Rox!

23:15:12 [kokushubila] Thanks 4 reminding me step 1

23:15:19 [Lorena] welcome back rox

23:15:24 [zeda] now happy

23:15:42 [crusher] dec t4 and normal tsh in excess ANDROGEN

23:15:50 [adam] do they do so step 1?

23:16:11 [vladi] crusher i told the same stuff above about sec mess for AT II

23:16:14 [sweta_chandra] sorry to disturb u guyes.. but am in need.. have to take &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 > from tommrow but when there in the payment section they have written about shipment and all.. kind'a confused,if someone can tell me how it goes, will be grateful.

23:16:16 [zeda] what chapters we will discuss on Sat.?

23:16:30 [Step_1] i missed your question adam?

23:17:20 [adam] I asked about the effect of andogens?

23:17:49 [Step_1] for sat, we will cover the remainder of physio (anything not covered tonight). I'm sorry but i cant make it sat....i'll be missing my first chat

23:18:05 [adam] Vladi, It is true the IP3, I just gave the explanation

23:18:10 [crusher] TELL ME THE LEVEL OF RENIN in prim and sec hyperaldosterinism

23:18:23 [Step_1]>[adam] androgens would do the opposite of the estrogen. that is it would decrease synthesis of TBG -> dec total T4 with normal TSH.

23:18:53 [sanya] in prim hyprealdo renin is dec, sec it is increased

23:18:53 [Roxanita] Step 1 please check your pm

23:19:07 [Lorena] we'll miss you step

23:19:25 [adam] renin dcreases

23:19:26 [Roxanita] what is for saturday Lorena?

23:19:28 [vladi] thanks, adam, i just missed that's Gq receptor

23:19:29 [Step_1]>[Roxanita] i saw it right before the chat, is that the pm you mean

23:19:32 [zeda] Thanks for the ans. step1,but will miss u

23:19:49 [crusher] give the reason why

23:19:58 [Roxanita] yeah please don't forget, I am freaked out with that

23:20:12 [zeda] Bye everybody,see u on Sat.

23:20:19 [Step_1]>[zeda] /TO Lorena thanks, i'll miss you all too. i will try to post some questions for everyone in the forum before sat to contribute to the subject

23:20:23 [adam] yes step 1, do you mean for those who take Androgens or in general?

23:20:37 [Roxanita] Tell me Lorena what's for saturday?

23:20:42 [adam] Wassup Rox? you are silent today?

23:20:45 [vladi] step 1 - come back next week- we'll miss you

23:21:12 [Roxanita] sorry, got diarrhea

23:21:16 [Step_1] yes, i believe so. my source is goljan page 183

23:21:23 [zeda] yes step1 ,try to join chat on Sat.

23:21:45 [adam] Oh dear! I am sorry!

23:22:02 [Roxanita] Oops I shouldn't be so sincere

23:22:14 [Step_1] i wish i could, but i'll be there for the rest of the chats and will try to contribute in the forum too

23:22:34 [Roxanita] Just kidding, I am just kind of sick

23:22:54 [vladi] Rox- indeed what happened to you

23:23:05 [adam] oh poor Rox! hope we are not making ya sickier here!

23:23:17 [Roxanita] can't tell. Please Step 1 don't forget

23:23:22 [Step_1] rox, are you leading us into a practice question

23:23:47 [Roxanita] of course not dear

23:23:52 [Step_1] i will take care of it right after the chat....promise

23:23:57 [adam] step 1. sorry, I didn't get ur point! Is it in patients on Androgens?

23:24:00 [Roxanita] Step_1> don't forget to edit that stuff

23:24:05 [vladi] step 1 - by the way thanks a lot for your new bunch of Qs in forum, i was happy to answer more than 50% of them

23:24:06 [adam] What is the second messanger of VIP?

23:24:30 [adam] wow, that is Great Vladi! I really found the CVS ones difficult

23:25:27 [Roxanita] Lorena?

23:25:50 Lorena enters this room

23:25:57 [Step_1]>[adam] yes. an increase in estrogens, like in preg, will cause an inc TBG syn which will inc total T4 (bound) with normal TSH. pts with inc androgens for whatever reason will have the opposite....dec TBG, so dec total T4 and normal TSH.

23:26:06 [Lorena] i had to restart the compu because it was blocked

23:26:22 [adam] thanks step 1

23:26:36 [crusher] no one is askin q

23:26:37 [adam] hummmmmmmm, Lorena ! WB!

23:26:51 [Lorena]

23:26:51 [sweta_chandra] someone plz help.

23:26:51 [Step_1] you're very welcome vladi, i'm glad they helped. i'll try to post some more from that same source for the rest of physio before sat.

23:27:00 [adam] i did crusher, what is the 2nd messanger in VIP?

23:27:03 [Lorena] what are you talking aboput now?

23:27:11 [sweta_chandra] is &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 > online and cd difft?

23:27:33 [vladi] let's guess-because it's protein - may be some sort of kinase e,g, phaspokinase

23:27:38 [Roxanita] I promise to come alive again

23:27:43 [Step_1]>[Roxanita] dont worry, i will make sure to take care of it....i promise

23:28:00 [Roxanita] thanks

23:28:03 [adam] what is the difference between constitutional exocytosis and regulated exocytosis?

23:28:12 [vladi] adam- i did not try CVS- i just did the other 2 blocks

23:28:15 [adam] No Rox? where ya goin?

23:28:17 [Roxanita] Lorena what's for next chat session?

23:28:36 [adam] oh Vladi, the CVS were really hard for me!

23:29:00 [Lorena] i guess we should discuss rebal, respiratory and GI ? and the rest that is left

23:29:23 [Roxanita] rebal?

23:29:34 [Lorena] renal

23:29:37 [Step_1] i dont know adam, never heard of that?

23:29:58 [adam] no Vladi , remeber tht both V.Cholera and Vipoma cause diarrhea through the increase in intracellular cAMP. okay?

23:30:12 [vladi] it's also my weak site- that's why i did not try it yet

23:30:26 [sanya] constitutional exocytosis : are not coated with clathrin

23:30:46 [Roxanita] Constitutive Exocitosis: continue fusion with Mb

23:31:15 [sanya] I'm sorry the vesicles are not coatd with clathrin and continuosly fusing with the membrane

23:31:22 [adam] constitutional exocytosis is by which cells expell proteins like Albumin. No need for a signal to release them while Regulated expcytosis is the process by which cells release Hormones. they need w signal to be released. ok, step 1?

23:31:56 ytrial enters this room

23:32:02 [adam] Regulated exocytosis also needs clarithrin coating! correct!

23:32:03 [Lorena] thanks adam

23:32:14 [Step_1] thanks adam, i couldnt find it in my notes so that helps alot

23:32:26 [Roxanita] Regulated Exoc: a signal is required and the vesicles are coated with Clathrin

23:32:42 [adam] Perfect Rox!

23:32:52 [Step_1] hi ytrial

23:33:01 [Step_1] should we switch to muscle physio soon to make sure we cover some of it tonight?

23:33:14 [adam] what is the difference between Flutamide and Leuprolide?

23:33:15 [Roxanita] I got to go to the bathroom...

23:33:27 [adam] sure step 1

23:33:49 [adam] Go Rox! I told you not to eat that Myanoese, see..........!

23:34:11 [sanya] step_1 where did you put the CVS Questions, can I take a look at it?

23:34:17 sweta_chandra enters this room

23:34:33 [adam] Calcium binds to what inside the muscle?

23:34:45 [vladi] thanks, adam- you are right- i forgot this same effect with cholera. That's what i ment to you- i've caught by myself that in real exam sometimes i can answer rigtht some difficult Qs, but failed pretty easy Qs- it's my paradox. That's why probably i don't want you repeat my mistakes

23:34:54 [sweta_chandra] is the &lt;a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >&lt;a target=new href="http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000058&type=3 &subid=0" >Kaplan&lt;/a>&lt;/a> &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>&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 >&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 > online same as &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>&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 >&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 > cd?

23:34:56 [adam] Lorena, where are ya?

23:35:13 [Lorena] hehe, sorry, just chatting with rox

23:35:28 [Lorena] back

23:35:33 [adam] it't okay, Thank you Vlado!

23:35:38 [Step_1] sweeta, try not to type things like kap lan, amaxon, first aid, etc

23:35:46 [vladi] Flutamaide- direct antianrogen, Leuprolige- LHRH-agonist

23:35:48 [adam] I told you girls, no side talks ;(

23:36:21 [sanya] calequestrin

23:36:54 [Step_1]>[sanya] the cardiac physiology questions (54 of them i think) can be found in the step 1 forum or just use this link http://www.valuemd.com/viewtopic.php?t=19752

23:37:15 [Lorena] mechanism of dark skin in patients with increased ACTH?

23:37:36 [Roxanita] Troponin binds to Ca++

23:37:43 [Lorena] opps, sorry did we change the subject? are we in muscle now?

23:37:54 [adam] Correct Vladi! Flutamide is an androgen receptor antagonist and Leuprolide is a GnRH analog that inhibits FSH and LH release. both used for the treatment of Prostatic cancer

23:38:04 [Step_1] thats ok, if you have a good question, go for it

23:38:09 [adam] correct Rox

23:38:35 [sanya] Thankyou step1

23:38:39 [Roxanita] Good Vladi

23:38:52 [Lorena] thanx step 1, i'll post them later then

23:38:54 [Step_1] you're welcome

23:39:01 [vladi] how about aborelix- they can ask that for prostate cancer

23:39:03 [adam] ACTH is produced from a precursor called Pre-opeomelanocortin which is a precusror of Melanin too. It causes increased melanin synthsis

23:39:17 nne enters this room

23:39:26 [adam] sorry it is a precusror of MSH

23:39:33 [Lorena] yes adam

23:39:42 [Step_1] what type of muscle is striated and which is nonstriated?

23:39:42 [adam] yes Lorena

23:39:46 [Step_1] hi nne

23:40:06 [adam] what is aborelix Vladi?

23:40:09 [vladi] thanks, rox- you are adorable person because you send me your happy face every time

23:40:16 [Lorena] smooth is not striated; skeletal and cardiac are striated

23:40:27 [Roxanita] Hi Hutals I always like to say Hi to you

23:40:36 [Step_1] skeletal and cardiac are striated and smooth muscle is nonstriated....very good lorena

23:40:57 [adam] Hi Hutals!

23:41:02 [hutals] hi roxanita, you found me hiding out

23:41:09 [hutals] hey adam

23:41:46 [Roxanita] Adam what are the T tubules?

23:41:50 [adam] which band doesn't shrink during muscle contraction?

23:42:17 [vladi] aborelix- it's actually new LHRH-antagonist (not agonist!!)- . by the way Tommy mentioned it in his notes

23:42:18 [Roxanita] A band

23:42:20 [Lorena] A band doesnt

23:42:25 [sanya] A band doesn't shorten

23:42:48 [vladi] I-band

23:42:56 [adam] I am not sure Rox, but I think that these are specialized extension of the Sarcoplasmic reticulum that you find in the Cardiac muscles. I am not sure though, am I right?

23:43:00 [Step_1] a band?

23:43:28 [adam] Vladi HIZ IZ the one that ShrinkZ, okay? A doesn't

23:43:53 [Step_1] the t tubular membranes are extensions of the surface membrane

23:43:56 [adam] H , I and Z shrink while doesn't

23:44:12 [adam] during muscle stretching which band doesn't elongate?

23:44:34 [sanya] T tubules are invaginations of the cell membrane at the Z lines which carry the Action potential to the interior and they are in close proximity to the terminal cisternae of the SR

23:45:00 crusher enters this room

23:45:06 [adam] thanks guys, you are right!

23:45:24 [adam] sorry, Rox! i couldn't help with this one

23:45:32 [Roxanita] ok let's see.... The T Tubules are extensions of the surface Mb

23:46:29 [Lorena] what provides the energy for the mechanicl aspect of contraction?

23:46:45 [adam] ATP

23:46:58 [Step_1] atp

23:47:02 [Roxanita] The Sarcoplasmic Reticulum is part of the Internal Mb system which store?...

23:47:14 [adam] Calcium

23:47:17 [crusher] ca

23:47:22 [Lorena] yes! the hydrolysis of atp by myosin atpase

23:47:38 [adam] wow, I got it right!

23:47:55 [Roxanita] In Sk muscle most of the Ca++ is stored in the TERMINAL CISTERNAE

23:48:04 [Lorena] calcium rox

23:48:17 [Roxanita] it's the same Sarcopl Reticulum

23:48:25 [Step_1] where is more energy consumed, during development of active tension or the actual shortening phase?

23:48:35 [crusher] yes in skeletal most in sarcoplamic reticulum

23:48:40 [Roxanita] what is your answer ADAM, for the "don't elongate"

23:48:52 [adam] detachement of Mysin from actin filaments depends occurs when..........binds to...........

23:48:54 [sanya] dev of active tension

23:48:59 [Lorena] active tension step1

23:49:09 [adam] A band too Rox, easy one, isn't it

23:49:19 [Step_1] most of the energy consumed during devlopment of active tension....very good

23:49:35 [adam] detachement of Mysin from actin filaments occurs when..........binds to...........

23:49:53 [vladi] what's regulatory muscle protein which lies in the grove of the F-actin helices

23:49:59 [Roxanita] hey Vladi, where are you?

23:50:09 [Lorena] occurs when the calcium dependent atp ase pumps calcium back to the sarcoplasmic reticulum

23:50:12 [sanya] atp binds to myosin

23:50:40 [adam] I asked Vladi a question about a drug she mentioned and she disapeared.

23:50:59 [adam] correct Sanya

23:51:09 [Roxanita] Which protein have the "attachment site" for the Cross Bridges?

23:51:23 [sanya] actin

23:51:37 [crusher] when trpnonin

23:51:37 [adam] actin

23:51:42 [Lorena] actin

23:51:57 [vladi] rox- i'm here- i can ask more if you want- e.g. what's form the swiunging cross bridges in sacromers

23:52:19 [Roxanita] Actin right guys

23:52:38 [vladi] rox- it's myosin heads SF1

23:52:53 [Roxanita] no, don't ask please

23:53:01 [adam] how do you guys get all these faces and cool stuff?

23:53:34 [Step_1] hit the question mark on the left and it will tell you the code to type

23:54:02 [Lorena] explain rigor mortis

23:54:04 [Roxanita] Myosin yup

23:54:11 [adam] a muscle is in rigor mortis, what is missing, ATP or ADP?

23:54:25 [Roxanita] the 2 heads like sister snakes, I got it

23:54:27 [sanya] ATP

23:54:34 [Lorena] atp

23:54:41 [Step_1] absence of atp stops cycling

23:55:05 [adam] :_albinorab

23:55:07 [Lorena] atp is depleted ca is not pumped back to the sarcoplasmic reticulum

23:55:12 [adam]

23:55:26 [adam] I did it, thanks!

23:55:34 [Step_1] you got it adam

23:55:39 [Lorena] the muscles stayed in the contraction state=rigos mortis

23:55:46 [adam] correct step 1

23:55:46 [Roxanita] Rigor Mortis when ATP is depleted

23:55:52 [vladi] adam- actually i am a male with a normal sexual orientation, probably you mixed me with linda from usmle.net- actually i replied to you about aborelix -check above

23:56:00 [Lorena] hahahahahaha

23:56:00 [adam] correct Rox, you are scaring me.

23:56:24 [Roxanita] cycle stops at position 3 TRIGOR MORTIS

23:56:42 [Lorena] si rox!!

23:56:52 [adam] I am sorry Vladi, excuse my ignorance of unfamiliar names to me. I appologize!

23:57:21 [Roxanita] nothing to be scared

23:57:23 [Step_1] Choose one correct answer. A. The A-band lengthens during relaxation. B. The I-band shortens during contraction. C. The A-band shortens during contraction D. None are correct.

23:57:41 ytrial exits from this room

23:57:49 [sanya] The I-band shortens during contraction.

23:57:54 ytrial exits from this room

23:57:56 [adam] B

23:57:58 [Roxanita] B)

23:58:01 [crusher] :-BUTTERFLY

23:58:25 [crusher] B

23:58:28 [vladi] it's all right, adam- don't take it seriously- i am here actually

23:58:38 [Step_1] Correct Answer: B good job

23:58:46 [Lorena]

23:58:56 [vladi] agree with B

23:59:02 [Lorena] these icons are fun!

23:59:11 [Roxanita] work out at home Lorena

23:59:50 [Roxanita] How many ATPases are involved in Contraction?

23:59:59 [adam] The Food and Drug Administration (FDA) today approved the New Drug Application (NDA) that permits marketing of Plenaxis (abarelix), a drug for advanced prostate cancer for patients who have no alternative therapy. The drug, indicated for the treatment of the symptoms of men with advanced prostate c

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

00:00:19 [Lorena] 2

00:00:34 [Roxanita] say it...

00:00:48 [crusher]

00:00:51 [adam] abarelix is a type of medicine (called a gonadotropin-releasing hormone (GnRH) antagonist) that lowers the male hormone testosterone, which is a key factor involved in most prostate cancer growth

00:01:08 [Lorena] calcium dependent atpase and the myosin atpase

00:01:14 [sanya] Ca atpase and Myosin atpase

00:01:35 [Roxanita] that's good

00:02:23 [Step_1]

00:02:53 [crusher] :-minner

00:02:59 [Roxanita] oh no everybody got nuts

00:02:59 [Lorena] when complete tetanus occur?

00:03:21 [crusher]

00:03:22 [adam] whats going on guys, I go for a minute , I come back and every body goes crazy

00:03:36 [vladi] that's right, adam, actually they approved some other drugs- e.g. taxotere. Actaully i would rather called this year for prostate cancer reasearch as year of breakthrough for taxotere. At last ASCO-meeting last week 3 large-scale trials proved their efficacy for hormone-resistant prostate cancer

00:03:48 [adam] when the toxin rather than the bactera is ingested

00:03:55 [sanya] when the interior of the cell gets saturated with Ca and all the crossbridges are cycling

00:04:01 [Lorena] tetanus

00:04:11 [Lorena] yes sanya! very good

00:04:23 [vladi] i told you about abarelix above

00:04:32 [Lorena] tetanus or botulinum toxin adam?

00:04:58 [Lorena] sorry not tetanus toxin....

00:05:53 [Step_1] when sufficient free ca is avail for continuous cycling of all cross bringes

00:05:59 [crusher] when sufficent free calcium is availanle for continuoes cycling of all avaliable cross bridges

00:06:12 [Step_1] oops....a little late with that ans

00:06:16 [Lorena] good job step 1 and crusher

00:06:34 [Step_1] i just got excited cause i finally located it

00:06:51 [Lorena] why cardiac muscle cannot get tetanised?

00:07:56 [Step_1] long electrical events prevents tentaby bc of length of a.p.

00:08:23 [crusher] when sufficent free calcium is availanle for continuoes cycling of all avaliable cross bridges

00:08:53 [Lorena] yes step 1

00:09:12 [Roxanita] b/c the effective Refractory period is pretty long, yup

00:09:56 [adam] Vladi, does this Taxotere have the same mechanism of action as Paclitaxel?

00:10:02 [Roxanita] Refractory period &lt;> Mechanical event (in time)

00:10:27 [Lorena] i wish i could stay longer but i am very hungry

00:10:32 [adam] sorry, Lorry I missed your question!

00:10:52 [Step_1] yes, i think its time to call it quits for me too

00:10:54 [Lorena] see you guys on saturday...will you be able to make it step 1? i got disconnected when you said so

00:11:00 [vladi] yes- it's two drug from taxan group

00:11:06 [adam] Lorena, what time is it now ate your side? you can't be eating now, its late!

00:11:10 [Roxanita] Lorena wait

00:11:17 [Roxanita] what's for saturday?

00:11:34 [Lorena] here it is 6:11pm and i just had breakfast

00:11:43 [Roxanita] she is 6 hours behind us Adam

00:11:48 [Step_1] i cant make it on sat, but i will be sure to post some relevant questions on physio in the forum for everyone

00:11:52 [Roxanita] well 5

00:11:58 [vladi] Rox- you did great, but i don't have my happy face to send you

00:12:04 [Lorena] for saturday i would suggest renal, respiratory

00:12:08 [sanya] guys i am tired too, bye & thanks to all of you!

00:12:17 [Roxanita] Lorena?

00:12:22 [Roxanita] happy face?

00:12:30 [adam] just had the breakfast and you hungry and why and where and how ? wow, you are studying so hard that you don't get time to eat, wow! Oh geeeeeeeee!

00:12:32 [Lorena] see you sanya!!! thanks for your inputs

00:12:33 [Step_1] you probably want to cover gi physio too

00:12:37 [crusher] bye sanya...i gotta go too

00:12:58 [Lorena] yes step , GI too

00:13:00 [Roxanita] See you on saturday Lorena.....for sure

00:13:05 [sanya] bye crusher

00:13:10 [Step_1] thanks for the great chat everyone. i learned alot like usual. goodnight to all

00:13:13 [Lorena] is that ok for you guys?

00:13:28 [Lorena] thank you roxanita!! dont abandon us!!

00:13:43 [Roxanita] Renal & Respiratory, that's all that is left

00:13:52 [Roxanita] what about GI

00:13:57 [vladi] adam- paclitaxel was not so effective as taxotere

00:14:04 [Lorena] see you guys, thank you!!!!

00:14:20 [Lorena] renal, respiratory and GI will be

00:14:21 [Roxanita] I will come

00:14:40 [adam] Thanks Vladi

00:14:43 merjo13 enters this room

00:14:49 [adam] Bye Lorena

00:15:22 [Step_1] bye

00:15:27 [vladi] taxotere (doxetacel) and paclitaxel (taxol)- where are from

00:15:29 [hutals] bye everyone

00:15:35 [Roxanita] I still can't change my face, but i need one with dark hair

00:15:39 [Lorena] bye (we'll miss you step )

00:15:53 [adam] are they from yews trees?

00:15:56 [Lorena] they dont have dark hair rox, i tried too

00:16:27 [adam] lol, you girls are going crazy on the hair color, aren't ya?

00:16:42 [vladi] adam- are you in Europe

00:16:47 [adam] is Rox trying to change the picture too?

00:17:28 [Roxanita] yes

00:17:36 [Lorena] :flyaway

00:17:39 [adam] no Vladi why but I was UK before I came here 8 months ago

00:17:47 [adam] why the question Vladi?

00:17:53 [vladi] as a matter of fact, i just got a nice supper and will still study a couple of hours

00:18:15 [Lorena]

00:18:18 [Roxanita] what is that vladi?

00:18:28 [Roxanita] Bye Lorenita

00:19:09 [adam] By Lorenita!

00:19:37 [adam]

00:20:17 [vladi] because you mentioned about breakfast, when i give a call to Europe- we are doing the opposite things- we-supper, they-breakfast

00:21:04 [adam] there is 6 hours difference between here and UK. They are 6 hours ahead of us

00:21:10 [adam] I am in chicago

00:21:12 [vladi] rox- it's just heart beats to you

00:21:35 [Roxanita] what is that my friend?

00:21:46 [adam] Rox, why you are still here!

00:22:04 [adam] lol, I meant Lorana!

00:22:10 [Roxanita] wanna see if I can change this face

00:22:53 [Roxanita] I sent you some material adam

00:22:59 [adam] lol, be happy with what you have . You are the best, the way you are!

00:23:12 [adam] Thanks Rox, I really appreciate it

00:23:17 [Roxanita] but try to get the last from those N guys

00:23:45 [vladi] rox-it's really my great attitude to you

00:23:50 [adam] I will do my best Rox. Thanks for your support.

00:24:00 [adam] is ur friend around here tonight?

00:24:18 [Roxanita] anytime for all of you guys, everybody

00:24:39 [Roxanita] she was gonna come but I came very late

00:24:43 [vladi] sorry other guys- we transformed the chat to the private discussion

00:25:07 [adam] Thanks again Rox

00:25:28 [adam] It's okay. I will keep doing things the best way i can

00:25:37 [Roxanita] what substances cross the membrane, polar or nonpolar?

00:25:51 [adam] Nonpolar

00:26:08 [vladi] probably we can finish for today

00:26:31 [Roxanita] this Q came... where the steroids are produced? and they had many organles... answer?

00:26:47 [adam] remember, the cell membrane is a lipid bilayer and for a substance to cross the membrane it should be nonpolar

00:27:06 [Roxanita] that kind of question come...the answer was Smooth ER

00:27:08 [adam] which steroids are ya talkin about?

00:27:19 [adam] oh yeah , right Rox

00:27:38 [Roxanita] it was a general question, steroid hormone

00:28:00 [adam] yeah and you were asking about the organels in the cell

00:28:12 [vladi] you mean SER

00:28:13 [Roxanita] Polar= Polite, so it stays outside of the cell Mb waiting for its receptor

00:28:20 [Roxanita] uhu SER

00:28:52 [adam] How does corticosteroids cause osteoporosis?

00:30:59 [Roxanita] tell me the Mx...

00:32:05 [adam] as you

I want reportage for cell organles