respiratory& renal chat transcript

[Lorena]

Filling in for step 1 , here is our last chat transcript 8)

We missed you step 1!
thanks for the questions you posted

see you all on wednesday to discuss Immunology

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20:48:18 [nne] hi

20:48:40 [nne] hi everyone

20:49:41 crusher enters this room

20:49:46 [nne] ace did you look at the questions posted by step 1 on respiratory physio

20:49:56 [nne] hi crusher

20:49:58 [crusher] hi everyone

20:50:30 [nne] crusher did you look at the questions?

20:50:34 [crusher] hi nne3.

20:51:59 [nne] If you did, what is the formula for calculating oxygen carrying capacity?

20:52:00 [crusher] no,what Q plz

20:52:59 [nne] Step 1 posted it under respiratory physiology questions

20:53:16 [nne] You can look it up now

20:53:16 [crusher] ok let me check it

20:53:32 [nne] its question 35

20:54:43 [acestep1] oops im so sorry nne

20:54:52 [acestep1] i was not here

20:55:02 [nne] ok

20:56:49 [nne] ace did you look at the question

20:59:49 Lorena enters this room

20:59:50 >[Lorena] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

21:00:24 [acestep1] no

21:01:00 [acestep1] but i remb its soemthing 2 do with % saturation or hb stauration

21:01:20 [Lorena] helo ace, crusher nne, and ggg

21:01:24 [acestep1] multiplied by the soluble O2

21:01:34 [acestep1] hi lorena

21:01:40 [crusher] hi lorena

21:01:41 [acestep1] how r u

21:01:48 [Lorena] :>

21:02:04 [acestep1] hey nne u want me 2 lk up teh q

21:02:17 [nne] hi lorena

21:02:31 [Lorena]

21:02:53 [acestep1]

21:03:19 [acestep1] hey how do u lk up teh q

21:03:35 [acestep1] imean without getting dc from the chat

21:04:51 Roxanita enters this room

21:05:12 [Lorena] hello roxanita

21:05:31 [Roxanita] Hello everybody

21:05:39 [acestep1] hi rox

21:05:41 [Lorena] step 1 wont be here today , we will miss him

21:05:43 [nne] hi

21:05:53 [Lorena] did you guys prepare questions?

21:05:55 [acestep1] awwwww

21:06:04 [Roxanita] Hi acestep1, nne, ggg, crusher, Lorena

21:06:12 [nne] lorena, pls start or roxanita

21:06:13 [crusher] definetly we willmiss him

21:06:15 [Roxanita] did you?

21:06:18 [acestep1]

21:06:25 [crusher] hi roxinata

21:06:37 [Lorena] what are the inspiration muscles?

21:06:54 [Lorena] i must say i just prepared respiratory

21:07:03 [nne] diaphragm

21:07:05 [acestep1] hey nne u want teh formala for o2capacity

21:07:06 [crusher] diaphram

21:07:20 [acestep1] agree with crusher

21:07:27 [nne] yes, ace

21:07:29 [Lorena] yes nne and crusher , and what else?

21:07:31 [acestep1] but tht normal resp

21:07:38 [Roxanita] inspiration muscles: Diaphragm and muscle of chest wall but mainly D

21:07:40 [acestep1] k just a sec

21:07:46 [crusher] causes rib to rise and inc APdiametewr

21:07:53 [Roxanita] what about Expiration m?

21:07:57 [Lorena] and the expiratory muscles?

21:07:59 [nne] intercoastals and some accessories

21:08:31 [Lorena] inspiratory besides diaphragm are external intercostals, scalene and sternocleidomastoid

21:08:44 [crusher] externalObliq,int oblique,recto abdominalmuscle

21:09:08 [crusher] and transverse abdominus

21:09:27 [Roxanita] Let's remember that Expiration is a PASSIVE process but when we do it forced we use abdominal muscles

21:09:29 [Lorena] expiratory are restus abduminus, external oblique and internal oblique , transvers abdominal

21:09:53 [crusher] what is the difference of DEAD space of EXPIRED Air and INSPIRED AIr

21:10:11 [Roxanita] and RECTOABDOMIANL is the most important, mainly on labor

21:10:26 [acestep1] hey nne for o2 capacity my bk just sat its teh max o2 bound 2 hb so if u know hb conc u know o2 capacity as well

21:10:41 [acestep1] k

21:10:48 [nne] air si filled in anatomical space

21:10:57 [Roxanita] Expired air will contain CO2

21:11:05 [nne] for expired air

21:11:06 [Lorena] very good

21:11:19 [Roxanita] Inspired O2 of course

21:11:25 [crusher] The ans is Expired air carry CO2 cos it is coming fromrespiratory zone .whi;le Inspired air is ROOMAIr devoid of Co2.

21:11:50 [nne] ok, thanks

21:11:52 [Roxanita] about lung volumes...Which ones you can obtain by Spirometry?

21:11:57 [Lorena] at the end of expiration dead space will be the same as respiratory zone contain

21:12:16 [Lorena] and at the end of inspitration will be humidified room air

21:12:21 [nne] what cannot be measured by a spirometer?

21:12:21 [crusher] tidalvol?

21:12:26 [acestep1] k. thnx lorena

21:12:43 [acestep1] residual vol

21:12:44 [crusher] yes v.good lorena

21:12:47 [Lorena] RV cannot be measured by spirometry

21:12:51 [Roxanita] Spirometry will obtain all but not the ones who contain RV on it

21:12:59 [Lorena] thank you

21:13:10 [nne] Everything except TLC, FRC, And RV

21:13:13 [crusher] no ace 1 you cannot measure Rv by spirometery

21:13:14 [Lorena] how do you measure those then?

21:13:22 [Roxanita] RV; TLC, FRC

21:13:39 [Roxanita] what will be on your question will be more "FRC"

21:13:45 [acestep1] hey crusher thts wht i said

21:13:57 [acestep1]

21:13:57 vladi enters this room

21:14:23 [Lorena] how do you measure residual volume?

21:14:27 [Roxanita] Hello Vladi

21:14:34 [acestep1] ic . thnx rox

21:14:40 [vladi] hi everybody

21:14:47 [acestep1] hi vladi

21:14:48 [Lorena] hi vladi

21:14:52 [crusher] ace the Q was which you CAN measure

21:14:57 [Roxanita] How do u measure RV?

21:15:07 [nne] hi vladi

21:15:07 yamini enters this room

21:15:12 [Lorena] helium disolution test

21:15:21 [crusher] hi vladi

21:15:35 [Lorena] helium disolution test helps to measure RV

21:15:40 [acestep1] hi yamini

21:15:45 [acestep1] k

21:15:51 [crusher] hi yamni

21:15:58 [yamini] hi everybody

21:16:00 [Lorena] hi yamini

21:16:04 [vladi] agree with Lor

21:16:13 [Roxanita] hello Yamini, good to see you

21:16:45 [acestep1] oh ok crusher sorry

21:16:52 [Roxanita] Good Lorena

21:16:54 [acestep1] . thnx

21:17:07 [crusher] noproblem ace

21:17:26 [acestep1]

21:17:27 [Lorena] why diothe lungs collapse in a pneumothorax?

21:17:35 dsa503 enters this room

21:17:38 [Roxanita] Differentiate Total Ventilation from Alveolar Ventilation

21:18:05 [crusher] cos of loss of recoil ??

21:18:06 [dsa503] hello everybody

21:18:08 [acestep1] hmm. i think +air pressure= atm pressure

21:18:15 [acestep1] hi dsa

21:18:15 [vladi] or body pletismography

21:18:21 [yamini] hi dsa503

21:18:24 [dsa503] hi ace

21:18:25 [crusher] hi dsa

21:18:28 [Roxanita] IPP increases to = Patm

21:18:49 [dsa503] hi yamini, crusher

21:19:00 [Lorena] no crusher

21:19:05 [acestep1] how r u

21:19:34 [Lorena] in pneumothorax ONLY recoil force is preserved , intrapleural in lost

21:19:40 [vladi] Lor- helium dilution (not disolution) technique

21:19:57 [Lorena] oh..thanks vladi

21:20:03 [crusher] inc intra pleural pressure,and equal to Atmpressure,and yes lung recoil also dec ,so thatr lung collasp

21:20:16 [Roxanita] If the Tidal Volume is 500ml, what is the alveolar ventilation VA?

21:20:23 [dsa503] not too bad ace

21:20:31 [vladi] actually spirometry cannot be used alone to measure FRC and TLC

21:20:36 [dsa503] haven't seen you at the chat for awhile

21:20:38 [Lorena] yes ace, + air presurre

21:20:43 [acestep1]

21:20:43 [crusher] 350 x r/r

21:21:06 [Roxanita] Hi dsa503

21:21:08 [acestep1] yes . wasnt well

21:21:27 [acestep1] soem personal probs

21:21:34 [acestep1]

21:21:45 [Lorena] hope everything is fine now ace

21:21:49 [Roxanita] that's good crusher, and what about same Vt and f= 20/min

21:22:01 [nne] Roxanita pls ans the question

21:22:10 [acestep1] yes. thnx lorena

21:22:10 [crusher] 350X15=5250

21:22:20 [dsa503] I hope everything is well now

21:22:30 [Roxanita] f=20

21:22:32 [nne] where is 15 from

21:22:33 [Lorena] total ventilation comprises also anatmical dead space, and alveolar ventilation is less the anatomical dead space rox?

21:22:39 [acestep1] yes .

21:22:49 [acestep1] thnx dsa

21:23:07 [Roxanita] yes Lorena

21:23:17 [dsa503] any time

21:23:18 [crusher] ok,then 350X20=i donot have cal

21:23:20 [acestep1] yes agree with lorena

21:23:34 [nne] I am lost/

21:23:38 [acestep1]

21:23:51 [dsa503] 15 is respiratory rate

21:23:53 [nne] your question was 500

21:24:07 [nne] Where did you get 350 from

21:24:26 [crusher] i assume 15 as f=resp rate ,but now isee rox gives f =20

21:24:43 [Roxanita] ok nne....the total ventilation is 500ml, but 150ml goes to fill first the dead space right

21:24:45 [dsa503] 350 is the tidal volume which is 500 minus the dead space which is 150

21:24:54 [crusher] 500 is tidal vol.150 is dead space.so you have to substract dead space

21:25:19 [nne] i see 15 in K AP

21:25:26 [Roxanita] so in just one time with 500ml coming in, 150 goes to the dead space and 350 come for alveolar ventilation

21:25:34 [crusher] right nne...

21:25:46 [nne] ok

21:25:59 [nne] thanks, i understand

21:26:06 [Roxanita] then you just multiply that times the frecuency= 350x20= 7000ml/min

21:26:43 [Lorena] very good rox!

21:26:52 [Lorena]

21:27:14 [Roxanita] therefore a patient that comes hyperventilating would be really having hypo alveolar ventilation

21:27:35 [Lorena] what increases alveolar ventilation more efficiently depth of breath or increase in rate of breathing?

21:27:52 [dsa503] depth of breathing

21:28:02 [Lorena] yes dsa

21:28:02 [nne] which do we go with 20 or 15

21:28:09 [Roxanita] when you see questions on shallow breathing this concept can come

21:28:13 [vladi] rate of frequency

21:28:24 [acestep1] k

21:28:26 [dsa503] what is the response of the lungs to high altitude

21:28:28 [Roxanita] depth breath of course

21:28:45 [Lorena] si rox

21:28:59 [Lorena] can you explain why? it is the same concept than in the exercise

21:29:01 [acestep1] inc resp rate

21:29:05 [dsa503] the normal respiratory rate is 15 to 20 average abt 18 I think

21:29:19 [Roxanita]

21:29:38 [nne] all factors increase except for pH that decreases

21:29:46 [crusher] donot worry in examthey will give you the value

21:29:51 [acestep1] yes dsa

21:30:21 [Roxanita] Lorena I don't understand your question

21:30:39 [dsa503] what are the factors that increase nne?

21:30:57 [dsa503] actually ph increases

21:31:23 [Lorena] why depth of breathing wiould increase alveolar ventilation more than increase in resopiratory rate (shallow breaths?

21:31:35 [nne] arterial ph increases

21:31:35 [vladi] agree with nne- both factors, because if you need the improve alv.ventilation anestiologist increase both parameters of artif.ventilation

21:31:41 [dsa503] because there is an acute & chronic increase in ventillation

21:32:27 [acestep1] im confused now

21:32:40 [nne] in <a href=http://www.amazon.com/exec/obidos/ASIN/0071429484/qid%3D1085033910/sr%3D2-1/valuetheplace-20>FA</a> it says everthing increases except ph

21:33:04 [dsa503] increased erythropoetin & increased 23 DPG

21:33:05 [nne] In in F A everthing increases except pH

21:33:21 [vladi] dsa- increase ph does not asffect ventilation - see Qs on respiratory that step 1 sent on forum, only acidosis affect alv.ventilation

21:33:24 [acestep1] k

21:33:29 [nne] In B RS everything Increase

21:33:34 [Roxanita] because from all the frequencies, always the first 150ml will keep on dead space so it doesn't contribute to alve vent. and mostly shallow breaths are low air containing

21:33:50 [dsa503] nne you are talking abt right shift oxygen dissociation curve

21:33:52 [crusher] yes ph will dec..shift to righ(right shift0

21:34:21 [nne] Yes i am , thanks for the correction

21:34:31 [Lorena] you guys are mixing HB curves with changes in high altitude

21:34:45 [dsa503] I am asking only abt the response to high altitude, they ask a lot abt that

21:35:03 [dsa503] yes lorena thanks for pointing that out

21:35:07 [acestep1] ic

21:35:20 [nne] Confusing.. just noticed i was making a mistake

21:35:27 [Lorena] very good rox!!! in a depth breath only 150ml are "lost" in the dead space .... but in shallow breaths for ech breath you loose 150ml

21:36:12 [acestep1] k

21:36:22 [dsa503] in response to high altitude the lungs respond by increasing ventillation both acute & chronic, increased 23 DPG, increased erythropoetin & increased renal excretion of bicarbonate

21:36:36 [nne] But in high altitude we have an increase in everything 23DPG, [Hb}

21:36:44 [Lorena] thank you dsa

21:37:05 [dsa503] sure anytime

21:37:28 [dsa503] yes nne

21:37:33 [Lorena] where does 2,3 DPG come from?

21:37:35 [acestep1] so acute is inc dpg n renal exc of hco3

21:37:53 [dsa503] there is a graph in caplan you can look at that too

21:37:54 [Roxanita] Both the Pao2 and the oxygen content of arterial blood (Cao2) are reduced in High Alt

21:37:54 [nne] tell us more about oxygen dissociation curve

21:37:59 [acestep1] n in chronic u have inc erythro

21:38:20 [vladi] nne-except increase pH

21:38:22 [acestep1] yes

21:38:52 [acestep1] agree with rox

21:38:52 [dsa503] I think acute will be only hyperventialltion the rest take awhile

21:39:10 [acestep1] ic.

21:39:14 [dsa503] & ph ofcourse

21:39:18 [acestep1] thnx dsa

21:39:31 [acestep1] k

21:39:39 [crusher] lorena what the ans of 2,3 BPG comes from?

21:40:24 [Lorena] from glycolisis , from 1-3 BPG

21:40:36 [dsa503] sure no pblm

21:40:48 [crusher] ok.thans,lori

21:41:22 [crusher] what willhappen toO2 content and o2 dissociation in ANEMIA

21:41:25 [Lorena]

21:41:30 [acestep1] hey crusher remb this happens

21:41:51 [acestep1] more in dec o2 states

21:42:21 [Lorena] oxygen content decreases in anemia for th decrease in Hb

21:42:29 [dsa503] no change in Po2 or the dissociation curve

21:42:43 [Lorena] but the P02 remains normal (free oxygen)

21:42:57 [crusher] what about boxygen saturation?

21:43:50 [Lorena] Hb is normally saturated , it is the arterial content taht is decreased?

21:44:07 [dsa503] agree with lorena

21:44:14 [Lorena] because the Hb is normal

21:44:30 [Lorena] i mean structurally normal but decreased in quantity

21:45:16 [acestep1] agree

21:47:03 [Roxanita] what do you mean crusher, what is your question?

21:47:21 [crusher] yes O2 saturation is the binding of O2 to Hb,each molecule of Hb bind 4 o2 molecules..soin anemia Hb binding is NORMAL,but amount is Reduced,so in anemia O2 saturation is NORMAL.good lorena

21:47:43 [Lorena] thank you crusher, good question

21:47:52 [Roxanita] ok I got it

21:47:57 [crusher] so the ans is in ANEMIA,O2 content is DEC and O2 sat is NORMAL

21:48:41 [Lorena] what is "dynamic compression of the airway"?

21:50:09 [vladi] very clear-crush, thanks

21:51:26 [acestep1] i havent studied resp so ill quiet

21:51:43 [Lorena] no ace, dont go

21:51:50 [dsa503] ok thanks crusher

21:51:52 [Lorena] stay with us

21:51:54 [acestep1] but is it compression from teh nearby structures

21:51:57 mika enters this room

21:52:02 [Roxanita] acestep1 did you study renal or GI?

21:52:25 [crusher] SO,NOW SAMEVALUE for polycemethia...

21:52:25 [acestep1] . thnx lorena

21:52:31 [acestep1] renal

21:52:38 [Lorena] yes ace! see !! during the expiration th epleural pressure becomes more popsitive and compress the airway

21:52:39 [acestep1]

21:52:43 [Roxanita] Good acestep1

21:53:01 [Roxanita] ok crusher

21:53:06 [acestep1] k . thnx

21:53:23 [acestep1]

21:53:39 [Lorena] thasw why you can exhale only 80% in the first second, because the intrapleural pressure compress more and more the airway

21:53:41 [dsa503] hey rox you are blonde today

21:53:47 [nne] we need to write out topics we will be discuusing in each subject every week, some us come prepared for something else and the rest are ready

21:54:34 [Roxanita] but my real hair is black as the night

21:54:47 [Roxanita] nne you are completely right about this

21:54:50 [acestep1] k

21:54:53 [dsa503] what is the ventillation perfusion mismatch in the apex of the lungs & the base of the lungs

21:55:04 [acestep1] yes

21:55:04 [vladi] Rox- how abour Qs at forum about different stuff of hypoxia

21:55:05 [Lorena] in polycythemia HB concentration is increased, oxygen content is increased too

21:55:06 [dsa503] mine too rox

21:55:12 [acestep1] lol

21:55:28 [crusher] now give me 3 conditionsin which O2 dissociation curve shift to LEFT?

21:56:01 [Roxanita] Apex: IPP is low and on base is higher

21:56:18 [Lorena] decreased temperature, decreased 2,3 DOG , also with FHb (shift to the left)

21:56:20 [crusher] right lorena and narmal )2 saturation and normal PaO2.in polycythemia

21:56:37 [dsa503] decreased Pco2 decreased H ions, & decreased temp

21:56:49 [Roxanita] ok , let me see

21:56:51 [nne] V/Q is increased

21:57:05 [nne] in apex

21:57:15 [acestep1] i think1 at teh apex n o.8 at teh base

21:57:36 [dsa503] good nne

21:57:37 [nne] and V/Q is decreased at the base

21:57:44 [crusher] yes you all are right additional,write it down somewhere..inc carbon monooxide,,inc methemoglobinemia and inc HbF

21:57:50 [dsa503] 1 is the ideal value

21:58:01 [dsa503] it is 3 in the apex & 0.8 in the base

21:58:24 [Lorena] rox, can you tell us about the questions about hypoxia you posted?

21:58:26 [acestep1] ic . bR- S says 1

21:58:38 [Roxanita] Which of the following Hypoxic conditions results from breathing atmospheric air at high altitude?...a) Hypoxic hypoxia

21:58:50 [acestep1] k crusher

21:59:28 [Roxanita] I will post all the answer tonigh ok?

21:59:39 [acestep1] k co cuz it displaces o2 n the o2 bind more tightly

21:59:58 [acestep1] is it the same for meth hb

22:00:11 [vladi] because gravity causes flow to be greater in dependent portions of lung, and aeration is also greater in the dependent portions, relationship between these pressures varies from to to bottom

22:00:38 [Lorena] thank you rox

22:00:44 [dsa503] good vladi

22:01:11 [Lorena] thanks vladi

22:01:16 [acestep1]

22:01:35 [Roxanita] Abou this mismatch...APEX: Increase PO2, pH>7,4; VA/Q>0,8 BASE: Increase PCO2, pH<7,4, VA/Q<0,8

22:01:58 [Roxanita] Then why the Mycobacterium TBC prefers the apex?

22:02:16 [Lorena] good question

22:02:20 [Roxanita] no problem Lorena

22:02:22 [crusher] cos the PO2 is greater in apex

22:02:38 [dsa503] because at the apex the aeration is high & M tb like more o2 concentration

22:02:41 [acestep1] yes agree

22:03:06 [Lorena] cauze Tb grows better at high 02

22:03:09 [Roxanita] aerobic guy huh?

22:03:51 [vladi] zone 1 (top)- alv pressure dominates, blood flow is flow PAlv.pr>Part>Pvenous

22:04:11 [Lorena] i always pictured mycobacterium as a girl

22:04:36 [crusher] what ismajor buffer of Intracellar and extracelluar.

22:04:39 [Roxanita] ok then aerobic girl

22:04:53 [acestep1]

22:05:05 [dsa503] proteins..?

22:05:14 [Roxanita] The basic respiratory rhythm is generated in the?

22:05:17 [vladi] zone 2- alv pres is in middle, therefore blood flow is determined by difference between art and alv pressures Pa>PA.Pv

22:05:21 [Lorena] aerobic mycobacterium...lol

22:05:37 [Lorena] pons

22:05:47 [acestep1] hco3 extracell n phosphates intra

22:05:59 [crusher] medulla

22:06:42 [vladi] zone 3: alv.pressure is small compared to other parameters, and blood flow is determined only by arterial and venous press Pa>Pv>PA

22:06:46 [Roxanita] The basic respiratory rhythm is generated in the?...ans: dorsal medulla

22:06:47 [crusher] extra cellular is HCO3.

22:07:09 [vladi] agree with crush-cerebellum

22:07:33 [Lorena] i am confused...because the pneomotaxic ceter is in the pons .....

22:07:45 [crusher] and intracellular i,mnot sure is phosphate or hemoglobin..can someonehelp?

22:07:50 [acestep1] oh for intra cell also hb

22:07:52 [vladi] Rox- closer to the wall of 4th ventricle

22:08:20 [crusher] i thinkmajor Ic is Hb

22:08:26 [Roxanita] At the end of a quiet inspiration, intralveolar pressure is normall? a) -40cmH20 ; b) -4 ; c) 0 ; d)14 ; e) 140

22:08:31 [Lorena] sorry crusher, what was the question?

22:08:42 [acestep1] yes . i agree crusher

22:08:54 [crusher] what are the major buffers of ECF and ICF

22:08:59 [Lorena] -4

22:09:04 [Roxanita] Respiratory center in the dorsal medulla

22:09:12 [vladi] sorry medulla, not cerebellum

22:09:26 [crusher] it was a Q.ban k Q

22:09:39 [Roxanita] In the Pons are the apneustic center and the pneumotaxic center

22:09:43 [Lorena] ECF bicarbonate

22:09:44 [acestep1] k

22:10:13 [crusher] fromwhich cellHco3 is generated and why?

22:10:15 [dsa503] ok thanks rox

22:10:30 [Lorena] thank you rox, i mixed that up

22:10:45 [vladi] always mild negative

22:11:03 [Roxanita] At the end of a quiet inspiration, intralveolar pressure is normall? a) -40cmH20 ; b) -4 ; c) 0 ; d)14 ; e) 140....ans: 0 cmH2O

22:11:45 jibbsie enters this room

22:11:58 [Lorena] oops

22:12:17 [Roxanita] Hello Jibbsie

22:12:23 [acestep1] rbc - crusher?

22:12:41 [acestep1] hi jibbsie

22:12:44 [Lorena] agree with ace

22:12:48 [vladi] oops

22:13:07 [Roxanita] RBC

22:13:10 [jibbsie] Hi everyone. My first time, and I had to come late

22:13:14 [crusher] yes v.good ace ,its Rbc cos only rbc carry enzyme carbonic anhydrase

22:13:15 [vladi] hi Jibbsie

22:13:34 [nne] you are welcome to this family

22:13:48 [Lorena] welcome jibbsie

22:14:00 [Roxanita] we are a real family huh

22:14:00 [acestep1] thnx crusher

22:14:12 [dsa503] hi jibsie

22:14:25 [jibbsie] Hi every one. Thanks

22:14:36 [acestep1]

22:14:38 [crusher] if a pat is hypoxic and but A-a gradiant is normal,how you will correct it,and wht type of defrect is this

22:14:49 [vladi] no problem-make yourself comfortable

22:15:04 [jibbsie] I can't see my messages

22:15:32 [acestep1] hey jibbsie we can

22:15:45 [Lorena] this is an hypoventilation problem

22:16:00 [Lorena] perfusiion limited situation

22:16:05 [jibbsie] Oh now I see. Hi everyone. Thanks. This is my first time.

22:16:06 [Lorena] increase ventilation

22:16:17 [vladi] defect in RBC

22:16:52 [crusher] yes..its hypoventilation defect and corrected by hyperventilation..right lorena

22:17:34 [Lorena] what would be the situation in a diffusion impairment?

22:17:47 [crusher] by hyperventliation co2 dec and O2 will inc

22:18:15 ttngo2 enters this room

22:18:37 [Lorena] you prepared very nicely crusher

22:18:41 [crusher] in diffusion impairment A-a gradiant inc lorena??/

22:19:16 [acestep1] i think A>a

22:19:20 [crusher] nolorena..i donot thinkso..ijust hear few k a p lecture still far behid

22:19:28 [Roxanita] Whenever there is a decrease in ALveolar Ventilation VA how do the pulmonary vessels respond?

22:19:33 [vladi] hi ttngo

22:19:57 [dsa503] vasoconstriction

22:20:04 [Roxanita] Welcome home ttngo2

22:20:17 [acestep1] constriction of the dec ventilation areas

22:20:35 [acestep1] so tht well o2 areas get o2

22:20:35 [Roxanita] why the vasoconstriction?

22:20:36 [Lorena] pulmonary end capillary p)2 is less than alveolar P02 , a diff will exist between them (A-a), supplemental oxygen will increase the fradient and return arterial p)2 to normal

22:21:03 [Lorena] p02 ...not p)2 ..sorry

22:21:10 [crusher] vasoconstriction ,so to supply the area....to provide o2 to efffected area

22:21:27 [vladi] crush- the above situation also may be in case of tension pneumothorax if you can get improvement of ventilation (?)

22:21:47 [Lorena] because that way it lows the blood flow in that unit

22:22:14 [Roxanita] very good guys lowering the Blood Q through that unit so the blood can be send to other effective areas

22:22:17 [Lorena] redirection the flow to the ventilated areas of the lung

22:23:36 [crusher] now the other Q,from in diffusion type defect,,,,how doyou corrrect it

22:24:10 [nne] at 11.30pm, we start with renals or GIT

22:24:13 [Lorena] with supplemental oxygen

22:24:28 [nne] sorry 11pm

22:24:53 [acestep1] k

22:25:02 [vladi] renal

22:25:11 [acestep1] but u guys cont im logging off. asm v tired

22:25:11 [crusher] yes supplementalO2 WILLCORRECT THE a-A DIFFERENCE.VERY GOOD.

22:25:30 [acestep1] am v tired

22:25:34 [nne] so that we can cover a lot more

22:25:49 [acestep1] cya guys in teh next session

22:26:02 [crusher] what is the diff b/w the pulmshunt and diffusion defect in terms of correction

22:26:07 [Lorena] take care ace!

22:26:09 [acestep1] take care all of u

22:26:19 [Roxanita] don't forget to review diver's questions, they like to put that on the exam

22:26:20 [acestep1] u2 lorena

22:26:27 [Roxanita] acestep1

22:26:28 [acestep1] bye

22:26:29 [crusher] see u later ace

22:26:36 [vladi] by ace

22:26:38 [crusher] bye ace

22:26:40 [Roxanita] but you are suposse to lead renal

22:26:46 [dsa503] bye ace take care

22:26:46 [acestep1] definitely crusher

22:26:50 [Lorena] pulmonary shunt doesn get corrected by administration of oxygen

22:26:56 [acestep1]

22:27:07 [acestep1] thnx dsa . u2

22:27:23 [acestep1] yes but rox i was up the whoel nite

22:27:38 [Roxanita] ok acestep take care, hope to see you next chat

22:27:55 [Lorena] if you want ace , we can start renal now

22:27:58 [acestep1] im sure u guys will b a v good job

22:28:07 [Roxanita] uhm sorry , go to sleep good boy

22:28:15 [crusher] in both pulm shunt and diffusion defect we give supplemental OH2 but complete recovery of A-a in diffusion typw defect while incomplete in pulm shunt

22:28:17 [acestep1] nono its ok u guys carry on

22:28:29 [acestep1]

22:28:40 [acestep1] hey rox im a girl

22:28:52 [acestep1]

22:29:00 [nne] saw a question on CO2 transport . High yield. The question is in the step 1 respiratory physiogy MCQ's

22:29:25 [acestep1] k

22:29:28 [Lorena] have your rest ace, and t5hanks for being here today

22:29:34 [Roxanita] sorry because you didn't change your hair style

22:29:49 [acestep1] whts the nne

22:29:58 [acestep1] q imean

22:30:02 [nne] i am also a gilr, how do i wear a hair

22:30:08 [acestep1] oh ok.

22:30:26 [acestep1] yes rox plz tell us

22:30:33 [acestep1] lol

22:30:51 [Lorena] cliak on your little doll you have next to your name

22:30:54 [vladi] nne- you mean CO2 not bind to the imidazol ring of glutamate

22:30:56 [crusher] click on your name icon and clickon girl

22:31:00 [Roxanita] ok, click on the little face and it will show a little window, just change your option for female

22:31:31 [acestep1] thnx

22:31:33 [Lorena]

22:31:47 [acestep1] lol

22:31:50 [Lorena] we rock girls!!

22:31:57 [vladi] common ladies- please speak about hair cut afterwards

22:32:12 [crusher] lol..

22:32:25 [Roxanita]

22:32:32 [Lorena] a little break

22:32:44 [acestep1] lol

22:33:22 [Lorena] nne...vladi....you studied for renal, right?

22:33:35 [Lorena] bring the questions on!

22:33:46 [nne] No

22:33:56 [acestep1] hmm . ok

22:33:58 [crusher] ok guys shoot renal

22:34:00 [vladi] yes

22:34:03 [nne] But i'll find some questions

22:34:04 [acestep1] clearance?

22:34:08 [Roxanita] Which of the following will increase in Obstructive but not in restrictive lung disease? a) VC ; b) maximum breathing capacity ; c) FEV1 ; d) FRC ; e) Breathing frequency

22:34:12 [Roxanita]

22:34:19 [acestep1] renal clearance imean

22:34:20 [nne] I read it sometime ago

22:34:43 [acestep1] c

22:34:54 [vladi] main differences between metanephron and mesonephron

22:35:24 [vladi] Rox- why you turn back to respi

22:35:28 [nne] Roxanita pls answer and explain the answer

22:35:28 [crusher] VC??/ rox

22:35:43 [Roxanita] I didin't know we were done

22:35:56 [acestep1] i think c rox

22:36:30 [Roxanita] Which of the following will increase in Obstructive but not in restrictive lung disease? a) VC ; b) maximum breathing capacity ; c) FEV1 ; d) FRC ; e) Breathing frequency. answer: d)

22:36:54 [crusher] i agree it will be D,now

22:37:09 sanya enters this room

22:37:10 [Roxanita] just go ahead with renal, I will post it later

22:37:21 [crusher] fev1 actually dec in obstructive

22:37:22 [Lorena] thanks rox!

22:37:48 [acestep1] oh ok

22:37:56 [sanya] Hi everyone, sorry I'm late!

22:38:09 [acestep1] ok guys formula for renal clearance

22:38:15 [Lorena] we just started renal sanya, good to see you

22:38:15 [Roxanita] Hi Sanya, great to see u

22:38:18 [acestep1] np sanya

22:38:24 [vladi] what's site of action osmotic diuretics

22:38:44 [acestep1] pct

22:38:52 [Lorena] vladi, what is the answer to your first question?

22:38:55 [crusher] loop of henle vladi

22:38:56 [vladi] loop diuretics

22:39:02 [yamini] pct

22:39:17 [dsa503] PCT

22:39:30 [yamini] thick ascending limb

22:39:37 [sanya] Thanks all of you, so shall start with renal!

22:39:41 [vladi] K-sparing diuretics, thiazides and aldosterone antagonists

22:39:54 [acestep1] agree with yamini for valdis q

22:40:05 [dsa503] what dilates the affarent arteriole

22:40:13 [crusher] distaltubule

22:40:34 [sanya] NSAIds can dilate AA

22:40:38 [vladi] osmotic- entire tubule barring the thick ascending limb

22:40:38 [acestep1] k sopring n alodsternoe in dct

22:40:51 [acestep1] yes agree with sanya

22:41:10 [acestep1] also maucula densa signals i suppose

22:41:24 [dsa503] yes prostaglandins dilate afferent arteriole

22:41:51 [crusher] which constrict efferent arteriole

22:42:01 [dsa503] so NSAIDS will constrict the AA

22:42:06 [vladi] loop- ascending limb, thiazide-early distal tubule, K-sparing- early collecting tubule, aldo antagon- distal coll. tubule

22:42:18 [acestep1] k. thnx dsa

22:42:46 [dsa503] what constricts the efferent arteriole?

22:42:52 [yamini] ang 2

22:42:59 [sanya] Yes guys I told the opposite actually NSAIDs will constrict AA becoz' they inhibit PG's

22:43:00 [acestep1] angio 2?

22:43:09 [dsa503] good yamini

22:43:25 [vladi] what's only one duretic that works on the blood site of nephron

22:43:57 [crusher] k sparing vladi

22:44:03 [acestep1] not sure vladi- carbonic anhydrase

22:44:53 [crusher] plz helpme in which CONSTRICT and which DILATE EFFERENt?

22:45:38 [sanya] Ag2 constricts EA and ACEI dilates EA

22:45:49 [dsa503] angiotentsin 2 constricts efferent arteiole & AT2 antagonists dilate it

22:46:07 [vladi] yes crush- it's spironolactone that binds to aldosterone receptors, what's its other main action

22:46:13 [dsa503] vladi what is the ans to your q

22:46:31 [crusher] and prostaglandin alsodilate effeent??

22:46:48 [dsa503] no afferent

22:46:53 [acestep1] pgs control afferent i think

22:47:09 [sanya] Main action of PG is on the AA and Nsaids block that

22:47:29 [crusher] thanks dsa n sanya

22:47:53 [dsa503] no pblm

22:47:58 [sanya] You're welcome crusher!

22:48:19 [acestep1] ok do u measure renal clearance

22:48:30 [acestep1] imean teh formula

22:48:57 [dsa503] volume of plasma cleared of a substance

22:49:21 [acestep1] yes v gd dsa

22:49:30 [acestep1] n formula

22:49:53 [crusher] is it GFR?

22:50:11 [sanya] U*V/P

22:50:22 [dsa503] urinary cocn* volume divided by the plasma cocn

22:50:38 [acestep1] u can measure gfr with it as well if u use inulin as u substance

22:50:52 [acestep1] yes v gd - dsa n sanya

22:50:58 [dsa503] no crusher the gfr is the glomerular filtration rate

22:51:14 [crusher] yep i got it ace as inuline neither secreted nor reabsorb

22:51:36 [acestep1] yes - crusher

22:51:46 [sanya] BUt GFR is more commonly measured by the creatinine clearance

22:51:46 [crusher] okdsa.

22:51:53 jibbsie enters this room

22:51:55 [vladi] for what we can use clearence of PAH

22:52:08 [sanya] Renal Plasma flow

22:52:23 [dsa503] yes thats right crusher but how is it measured clinically

22:52:26 [crusher] RPF

22:52:27 [acestep1] yes agree with sanya

22:52:50 [Lorena] sorry, i have to go guys besides that i didnt study renal i must leave now but i'll leave the computer on so i can post the transcript later, ok?

22:52:51 [vladi] great sanya

22:53:07 [Lorena] see you next chat on wednesday

22:53:14 [sanya] BYe Lorena!

22:53:14 [acestep1] hey . np lorena

22:53:24 [crusher] see ya lorena

22:53:26 [acestep1]

22:53:34 [acestep1] take care

22:53:38 [vladi] but inulin for FGR, creatinin we use in practice bz it closer to inulin action

22:53:43 [dsa503] lorena we will miss your great questions

22:54:00 [dsa503] good job vladi

22:54:05 [Lorena] enjoy your chat, bye everybody

22:54:07 [vladi] by LOr

22:54:14 [acestep1] yesa gree with vladi

22:54:20 [jibbsie] My pc is acting up. I guess I'll wait and read the transcript. I love reading contributions from you all. And, hey, thanks for welcoming me into the family

22:54:26 [acestep1] . byee

22:54:52 [Lorena]

22:55:17 [acestep1] take care jibbsie

22:55:28 [dsa503] bye lorena

22:55:31 [acestep1] lol. cute- lorena

22:55:32 [crusher] bye jibbsie

22:55:39 [dsa503] bye jibsee

22:56:14 [acestep1] ok how can renal bld flow b measured

22:55:17 [acestep1] take care jibbsie

22:55:28 [dsa503] bye lorena

22:55:31 [acestep1] lol. cute- lorena

22:55:32 [crusher] bye jibbsie

22:55:39 [dsa503] bye jibsee

22:56:14 [acestep1] ok how can renal bld flow b measured

22:56:48 [crusher] which part of inuline you will find highest conc in a nephron

22:57:02 [sanya] ERP/1-HCT

22:57:22 [acestep1] good

22:57:27 [crusher] RPF/1-HCT

22:57:43 [sanya] Inulin: is it the collecting ducts after the max absp of water

22:58:01 [acestep1] also q=p/r

22:58:04 [crusher] good sanya.

22:58:30 [crusher] where is highest conc of glucose ?

22:58:49 [acestep1] pct

22:59:00 [dsa503] loop of henle

22:59:02 [acestep1] 100%absorption in it

22:59:38 [crusher] above in prox tublue cos 100% reabsorb in PCT

23:00:02 [acestep1] yes. thst wht i meant

23:00:13 [crusher] I MEAN BEFORE ENTERING IN PROX TUBULE

23:00:14 [dsa503] ok

23:00:27 [vladi] early PCT- "workhorse of nephron" bz all glucose reabsorbs there

23:00:27 [acestep1] k

23:00:28 [sanya] Highest conc in the Bowman's capsule and then in the proximal partof PT almost everything is absorbed if the glucose conc does not saturate the carriers.

23:00:43 [acestep1] yes. agree

23:01:26 [acestep1] hey guys im really tired. must log off now

23:01:31 [crusher] WHAT IS tMAND WHAT ISSPLAY?

23:01:50 [crusher] Tm i mean

23:01:51 [acestep1] cya guys next week . take care till then

23:02:04 [crusher] ok ace u need some rest.take care

23:02:13 [nne] bye

23:02:28 [acestep1] yes . thnx crusher

23:02:30 [dsa503] bye ace take care

23:02:35 [acestep1] bye nne

23:02:52 [acestep1] bye dsa . u2

23:03:09 [sanya] Splay is when some of the carriers start getting saturated, which is the treshold and this around 250 for glucose, Tmax is when all carriers are sturated and this around 350mg

23:03:14 [vladi] bye

23:03:27 [crusher] cannot see roxinata

23:03:35 [sanya] Bye ace!

23:04:19 [vladi] rox silently escaped

23:04:26 [crusher] very good sanya..splay is the starting of saturating carrier n Tm is fully saturated

23:04:32 [sanya] What does aldosterone do to the clerance of Sodium?

23:05:18 [crusher] distaltubule sanya?

23:05:32 period1 enters this room

23:06:12 [sanya] No crusher I asked what happens to the clearance increased or dec

23:06:40 [crusher] oh ok,,dec clearence

23:07:04 [sanya] good, right

23:07:24 [crusher] sorry imisunderstood the Q

23:09:29 [sanya] Hey has everyone left then I'm leaving too

23:09:40 [crusher] i,mstill there

23:09:49 [crusher] hey vladi u there

23:10:17 [crusher] dsa???

23:10:46 [vladi] yes-i'm still here

23:10:58 [sanya] Hey crusher lat's stop too

23:11:27 [crusher] ok,it seems noone left

23:12:18 [sanya] By crusher nad vladi shall see you for the next chat, hopefully if I read something

23:12:19 [vladi] agree- today it's very sluggish discussion w/o sparkls

23:12:28 [sanya] I meant BYE!

23:12:54 [crusher] yeah,,not step1,neither adam,,,

23:13:05 [crusher] bye sanya

23:13:18 [yamini] bye sanya

23:13:47 [sanya] Bye Yamini!

23:13:52 [crusher] so,is someoneleft for putting Q,s

23:13:55 [vladi] by crusher

23:14:19 [vladi] bye everybody

23:14:43 [yamini] bye vladi

23:16:03 [yamini] what is the function of macula densa?