chat transcipt - Path (cardiac, cell injury, resp, and neopl

[Anonymous]

21:07:30 [Step_1] i think that roxanita posted a detailed schedule of path topics

21:07:39 [Lorena] yes, we usually say that in the chat , but i will post whatever we agree to discuss

21:07:51 [nne] where/

21:08:21 [zeda] please tell me which is the best material available if i want to chhose one?

21:08:42 jwls29 enters this room

21:08:44 [Step_1] http://www.valuemd.com/viewtopic.php?p=97486#97486

21:08:46 [zeda] k a p or g o l j a n

21:08:46 [crusher] goljian if you can grasp..

21:09:01 [crusher] if not than brs is fine

21:09:10 [neurodoctor_75] think goljan and &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 >

21:09:25 [jwls29] Hi. Is this the path discussion?

21:09:32 [zeda] k a p has no rating?

21:09:45 [Step_1] hi jwls

21:09:46 [Lorena] yes jwls, welcome

21:10:16 [Step_1] yes today is path, including cardio, resp, neoplasia, etc. sat will be remainder of path

21:10:24 [Step_1] ready to get started

21:10:30 [jwls29] Lol

21:10:32 [jwls29] soory

21:10:32 [Lorena] yes

21:10:50 [jwls29] i was looking at the bottom of the screen and couldn't see where i was posting

21:10:52 [jwls29] hello all

21:11:06 [Step_1] you hear fixed splitting in s2...is this normal or pathologic

21:11:07 [crusher] ok lets get started

21:11:30 [zeda] which topic we will finish first?

21:11:32 [Lorena] you can change the color of your letters for a more easy one to see on the rainbow on the left

21:11:33 [Step_1] jwls, you might want to pick a brighter color on the rainbow to the right

21:11:34 [crusher] pathologic commonly on ASD

21:11:44 [jwls29] how's this

21:11:59 [Step_1] oops sorry, i assumed cardiac....but whatever you prefer.

21:12:01 [Lorena] sorry ..right (always do the same mistake)

21:12:06 [Step_1] much better jwls

21:12:27 [jwls29] ok

21:13:20 [Step_1] thats right crusher.

21:13:39 [Step_1] what about s3?

21:13:58 [Step_1] is it normal to hear or abnormal?

21:14:12 [jwls29] isn't s3 pathologic too and should only be heard in children and elderly?

21:14:21 [crusher] S3 is normal is old age but pathologic in vol overload

21:14:24 merjo13 enters this room

21:14:33 [Lorena] abnormal

21:14:35 [merjo13] Hi all

21:14:51 [Step_1] normal in children and young adults, but abnormal after 40 yo....first sign of chf....good

21:15:01 [zeda] vasculitis of the elderly,presenting as headache,facial pain and impaired vision...Dx?

21:15:12 [jwls29] what about in elderly?

21:15:14 [Lorena] temporal arteritis

21:15:19 [crusher] temporal arteritis

21:15:25 [Step_1] temporal arteritis

21:15:35 [zeda] right

21:15:42 [neurodoctor_75] temporal arteritis

21:16:01 [Lorena] what vessels are involved ?

21:16:16 [Step_1] elderly should not have s3 because indicates volume overloaded right heart

21:16:18 [Lorena] besides temporal artery

21:16:27 [Step_1] but most probably do

21:16:32 [jwls29] ok

21:16:41 [jwls29] opthalmic art?

21:17:19 [Step_1] extracranial branches of carotid artery

21:17:21 [crusher] opthalmic also risk for blindness

21:17:43 [zeda] which art. are associated in Buerger dis.?

21:17:44 [Lorena] yes! good job

21:17:58 [Step_1] what is the treatment of temporal arteritis....give immediately to prevent blindness?

21:18:11 [jwls29] steroids

21:18:15 [crusher] corticosteroids

21:18:16 [neurodoctor_75] some problem in my computer.

21:18:26 [Lorena] small and medium size arteries and veins mostly in inf extremities

21:18:38 [Lorena] agree steroids

21:18:49 [crusher] med size vessels for Buerger dis

21:18:51 [jwls29] i thought it was in upper arteries

21:18:59 [jwls29] i mean upper extremities

21:19:01 [Step_1] agree with lorena and crusher for buerger.

21:19:10 [zeda] tibial and radial art.

21:19:11 [jwls29] this is the one associated with heavy smokers, right?

21:19:14 [Step_1] and yes corticosteroids....good job everyone

21:19:18 [Lorena] for buerger is inf extremities

21:19:42 [zeda] yes,assoc. with cigarette smoking

21:20:01 [zeda] also called thromboangitis obliterans

21:20:18 [jwls29] ok

21:20:23 [crusher] what is the most suspetible site in liver for Free radical injury??

21:20:38 [zeda] around central V.

21:20:41 [jwls29] i just checked my &lt;a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan&lt;/a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491.10002441&type=3&sub id=0 > and it does not say which extremities. just says extremities

21:20:55 [Lorena] around central vein , zone 1

21:20:58 [jwls29] yikes

21:21:03 [jwls29] what is all that?

21:21:15 [crusher] buerger can also gluteal with gangrene of foot

21:21:25 [Step_1] jwls, try not to post the word kap lan, or first aid, amaxon, etc

21:21:31 [Lorena] jwls , they present with claudication....because inf extremities

21:21:33 [crusher] good.its in central vein zone 1

21:21:33 [jwls29] i don't know what i did

21:21:34 [zeda] yes

21:21:43 [Step_1] it will auto convert into a link like above

21:22:03 [jwls29] what are all those links?

21:22:30 [zeda] don't type book's or course's name here

21:22:37 [crusher] what are the free radicals for O2 and H20?

21:22:38 [zeda] t will go to direct links

21:22:40 [jwls29] ok

21:22:42 [jwls29] i won't

21:22:45 [jwls29] thanks

21:22:51 [Step_1] during game, young basketball player collapses and dies immediately. what type of cardiac disease likely?

21:22:56 [zeda] superoxide

21:23:08 [crusher] IHDS

21:23:21 [Lorena] superoxid anoin, hydroxyl radicals

21:23:24 [jwls29] hypertrophic cardiomyopathy

21:23:34 [Lorena] hypertrophic cardiomyopathy

21:23:41 [Step_1] hypertrophic cardiomyopathy.....there is a good post with pics about it. i'll try to find it and post the link tommorrow. good job

21:24:00 [zeda] hypertrophic cardiomyopathy and its rare

21:24:26 [Step_1] its rare, but often tested for some reason....dont ask me why?

21:24:32 [jwls29] what type of coarctation is associated with Turner's sdme? preductal or postductal?

21:24:46 [Lorena] preductal

21:24:50 [crusher] what are the neutrolizers of free radicals and how they work?

21:24:57 [Step_1] preductal

21:25:00 [jwls29] yup

21:25:02 [zeda] jwls...please change your color

21:25:07 [nne] preducta

21:25:21 [jwls29] lighter or darker?

21:25:38 [Lorena] superoxide dismutase, glutathione peroxidase

21:25:42 [zeda] purple is hard to read

21:25:50 [jwls29] is this better?

21:25:59 [zeda] yes..thanks

21:26:08 [Lorena] much better jwls, thanx

21:26:14 [jwls29] no prob

21:26:29 [Step_1] asian woman 33 yo presents with absent upper extremity pulse, but high bp in lower extremity. also has visual disturbances. Most likely diagnosis.

21:26:50 [jwls29] takayasu's arteritis

21:26:56 [Lorena] takayasu

21:27:18 [zeda] name one cong. abnormality which predisposes to aortic stenosis?

21:27:21 [Step_1] takayasu disease is correct. "can't taka yoy pulse"

21:27:25 [crusher] yes lorena superoxide dismutase ,glutathione ,N.acetylcystein,antioxidant like VIT E,C and selenium

21:27:33 [nne] takayasu

21:27:41 [crusher] coraction of aorta

21:28:04 [Lorena] i dont remember EXACtly how they work though

21:28:09 [zeda] bicuspid aortic valve

21:28:11 [jwls29] me neither

21:28:51 [nne] i think its coarctation of aorta that is right

21:29:16 [nne] takayasu is usually pulseless

21:30:01 [Step_1] microangiopathic hemolytic anemia with schistocuytes is associated with aortic stenosis

21:30:02 [crusher] they neutralizes the Fr and prevent the damGE OF cell membrane by LIPID PEROXIDATION ,in which FR combine with molecular O2

21:30:06 [nne] with asian there takayasu is correct

21:30:30 [Lorena] thank you crusher

21:30:41 [Step_1]>[nne] yes, the asian woman was takayasu

21:30:43 [jwls29] thank you

21:31:41 [Step_1] mneumonic is "can't taka ya pulse" because can't take pulse = takayasu

21:31:45 [crusher] free radicals r usmle fav topic

21:31:47 [Lorena] what coagulation path & factor you test with prothrombin time test?

21:31:59 [zeda] upper extremity hypertension with lower extre. hypotension..Dx?

21:32:18 [Step_1]>[zeda] coarctation of aorta

21:32:21 [jwls29] coarctation of the aorta

21:32:35 [crusher] coarction of aorta

21:32:35 [zeda] postductal...right

21:32:46 [Step_1]>[Lorena] extrinsic path

21:32:49 [Lorena] coarctatuion of aorta post ductal

21:32:51 [jwls29] intrinsic path don't know the factor

21:32:56 [zeda] how will u detect it on x-***?

21:33:11 [jwls29] notching of the ribs

21:33:17 [crusher] what does n.acetylcystein do for poisioning with acetaminophan

21:33:20 [Lorena] yes step 1 , extrinsic path

21:33:34 [zeda] right

21:34:04 [jwls29] so prothromin is for extrinsic?

21:34:10 [jwls29] i always get that confused

21:34:20 [Step_1] I remember that because PeT and PiTT both make words. PT extrinsic and PTT is intrinsic

21:34:32 [jwls29] cool

21:34:40 [jwls29] now i'll remember

21:34:48 [Lorena] yes, prothrombin for extrinsic path

21:34:55 [Lorena] and common

21:35:02 sanya enters this room

21:35:24 [Step_1] hi sanya

21:35:29 [jwls29] what about crusher's question about the n acetylcystein?

21:35:38 [zeda] hi sanya

21:35:41 [sanya] Hi step_1

21:35:51 [Lorena] i dont remember ...

21:35:51 [zeda] crusher pl. ans

21:35:52 [sanya] Hi to all of you!

21:35:52 [Step_1] i didnt see crushers question

21:35:56 [jwls29] thanx lorena

21:36:06 [Step_1] now i see it

21:36:28 [Lorena] hi sanya

21:36:46 [Step_1] you give it for GSH or something. that is aka mucomyst which is used in CF and other pulmonary diseases too

21:36:50 [jwls29] hi sanya

21:38:06 [crusher] replenish gulathione..

21:38:42 [sanya] n-acetyl cysteine increases production of glutathione which is depleted in acetaminophen poisoning

21:38:51 [crusher] i,m sorry i was away,,my lill one askin something

21:39:06 [crusher] yes right sanya

21:39:52 [Lorena] for glutathione peroxidase?

21:40:30 [Step_1] printzmetals angina. stress ECG will show what? increase or decrease of what?

21:40:45 [sanya] what are we doing now I mean which chapter

21:40:51 GABA enters this room

21:40:52 [crusher] inc St seg elevation

21:41:03 [sanya] St elevation

21:41:04 [Lorena] ST elevation

21:41:06 [Step_1] still cardia path

21:41:27 [Lorena] we are jumping around sanya....from cell injury to cardiac and back

21:41:30 [sanya] OK Thankyou!

21:41:33 [Step_1] printzmetals will show elevated ST....where is ischemia....transmural or subendocardial

21:41:56 [Lorena] transmural

21:42:20 [Step_1] should we be on cell injury? we can ask those questions instead?

21:42:58 [jwls29] transmural

21:43:03 [zeda] associated factors with dilated cardiomyopathy?

21:43:09 [Lorena] i dont mind jumping or following by chapters , whatever you prefer

21:43:17 [Step_1] yes, its transmural because increase st. so what gives depressed ST and subendocardial ischemia?

21:43:39 [crusher] angina

21:43:42 [Lorena] alcohol, drugs, virus, parasites

21:43:50 [jwls29] stable angina

21:43:55 [Lorena] subendocardial

21:44:04 [GABA] angina

21:44:10 [Step_1] exertional (classical) angina gives depressed ST. relieved by nitoglycerin

21:44:40 [Step_1] hi gaba

21:44:59 [Lorena] yes, classical angina is a subendocardial ischemia = ST depression

21:45:12 [zeda] right lorena.......also pregnancy,can also be idipathic

21:45:22 [crusher] what is cause of met.Hb .nemia

21:46:00 [Lorena] carbo monoxide intoxication

21:46:23 [sanya] water with nitrites?

21:46:50 [zeda] oxidizing agents ..like nitrite or sulfur containig drugs

21:47:02 [Lorena] dapsone too

21:47:12 [Step_1] o2 content decreased. can be caused by tmp-smx treatment (i.e. tx of PCP in Aids pt...real test question)

21:47:27 [zeda] and defi. of metHb reductase

21:48:15 [Step_1] heme is stuck in iron + state so cannot bind O2

21:48:18 [crusher] Fe in Ferric state instead of ferrous state.(Fe sholud be in ferrous state to bind O2) result in dec O2 content dec Saturation of O2.person seems to be blue

21:48:23 [Lorena] thanks step

21:48:30 [Step_1] oops iron +3 state

21:49:00 [zeda] thanks step1 and crusher

21:49:09 [Step_1] treatment is IV meth blue and ascorbic acid (vit c)

21:49:19 [crusher] Tx of choice is methylene blue ,which inhances the conversion of Fe to ferrous state

21:49:28 [Step_1] real test question....best marker within 10 hrs of MI? choices were CKMB, troponin, LDH

21:49:43 [zeda] what are the mitochondrial toxins?

21:49:50 [crusher] tro[ponin

21:49:56 [sanya] troponin

21:49:56 [Lorena] troponin

21:50:01 [merjo13] Troponin

21:50:02 [zeda] CKMB

21:50:20 [crusher] what does ascorbic acid role?

21:50:20 [jwls29] troponin

21:50:36 [merjo13] Ascorbic- reducing agent

21:50:40 [Step_1] i dont have the ans because it is a recall, but i think it is ck mb according to goljan....not sure

21:50:47 [Lorena] agre with merjo

21:51:04 [Lorena] tricky

21:51:08 [crusher] i think troponin is more specific

21:51:15 [zeda] thanks step1...i thought i am wrong...but as i remeber this too

21:51:21 [Lorena] me too

21:51:35 [zeda] but need to check again

21:52:07 [zeda] i checked.....it is CK-MB

21:52:17 [nne] ist 24 hrs CK MB ACCORDING TO F A

21:52:18 [merjo13] Oh thanks

21:52:41 [jwls29] in the path book by cap ihave ck mb elevated by 4-8 hrs

21:52:41 [Lorena] ic

21:52:54 [nne] TROPONIN I IS IST 4 HRS TILL 7 - 10 DAYS

21:52:56 [crusher] oh ok

21:53:32 [nne] LDH1 IS FROM 2-7 DAYS

21:53:50 [Lorena] then why not troponin? if it is from4 hrs to 10 days ....confusing

21:54:02 [nne] IST 4 HRS ECG IS MOST APPROPRIATE

21:54:05 [jwls29] and troponin 3-6 hours

21:54:16 [jwls29] so which would be right?

21:54:35 [Step_1] that one really had me. goljan mentioned it in his audios, but not so clear in his notes. still confused about answer.... but real question

21:54:35 [sanya] Goljan notes says CK-MB increases 4-8hrs peaks in 24hrs disappears in 1.5 to 3 3days.

21:54:59 [nne] TEST OF CHOICE FOR 1SY 24 HRS IS CK- MB AS IT IS WRITTEN IN F A

21:55:10 [Lorena] at 10 hours post MI both are elevated.... but the questions is which one is the best marker?

21:55:27 [jwls29] wouldn't it be troponin?

21:55:39 [jwls29] i've always understood that that one is more specific

21:55:50 [sanya] both types of troponin increase in 3 to 12 hrs, since they all increase by 12hrs I think CK-MB is the RIGHT one

21:56:25 [Lorena] why?

21:56:54 [Step_1] i'll try to listen to that section of goljan again and provide some feedback in the forum hopefully tomorrow

21:57:17 [sanya] what I meant is since troponins only increase but does not peak CKMB is right

21:57:33 [Step_1] sorry for the question, but better to figure it out now that in the test

21:57:54 [jwls29] i have that the troponins peak at 16 hours

21:58:00 [Lorena] troponins do peak (at 16 hrs)

21:58:10 [nne] NO DON'T APOLOGISE FOR HELPING EVERYONE LEARN

21:58:24 [Lorena] yes step, excellent question

21:58:43 [Lorena] jus trying to figure out which one and why

21:58:45 [jwls29] exactly...i rather know for sure know than be staring at my computer the day of the exam

21:58:48 [sanya] goljan notes says T peks in 24hrs

21:59:00 [sanya] sorry peaks

21:59:31 [Step_1] i usually have the correct answers to the questions prepared...this one just had me stumped

21:59:32 [jwls29] yeah the guy from kap says that they are all going to say different times but they are all about in the same range

21:59:59 [jwls29] meaning different books will say differnt times

22:00:14 [Lorena] i see

22:00:50 [Lorena] ok, lets move on and look for that in dif sources

22:00:58 [jwls29] ok

22:01:11 [crusher] which IHD is most common

22:01:42 [nne] MI

22:01:52 [neurodoctor_75] angina

22:01:53 [sanya] angina pectoris

22:02:17 [Lorena] angina agree

22:02:20 [crusher] yes its angina pectoris

22:03:27 [Lorena] what are lines of zahn?

22:04:52 [jwls29] platelets and wbc's?

22:05:25 [jwls29] found in thrombus

22:05:40 [Lorena] close...platelets and RBC so they lookm like alternating pink bands

22:05:55 [jwls29] thanks

22:06:02 [sanya] what is Ejection fraction in systolic dysfuntion & in diastolic dysfuntion

22:06:05 [Lorena] yes, thats the difn witha blood clot - no platelets in blood clot

22:06:17 [Step_1]

22:06:18 [crusher] ok good to know lorena.tx\

22:06:25 [Step_1] oops...that didnt work

22:06:53 [Lorena] ejection fraction is decreased in systolic dysfunction

22:07:57 [sanya] right lorena

22:08:13 [Lorena] and in diastolic dysfunction is... ..... could be normal?

22:09:04 [jwls29] don't know this one

22:09:08 [Step_1] that one makes sense because ejection fraction is the fraction of blood pumped out of heart. blood is pumped out during systole....makes sense

22:09:39 [Step_1] i think??

22:09:57 [crusher] in diastolic dysfunction its inc

22:09:59 [Lorena] yes step

22:10:49 [Lorena] how is in dyastolic dysfunction sanya?

22:11:01 [neurodoctor_75] during diastole,inc why

22:11:04 [sanya] yes its normal that's one way to differentiate whether the cause is sys or dia dysfunction, pretty important in step2

22:11:15 zeda enters this room

22:11:32 [Step_1] thanks

22:11:34 [crusher] why its normal in diastole

22:11:40 [Lorena] thanks sanya

22:12:00 [Step_1] what gives a high pitched blowing murmur directly after S2?

22:13:47 [Lorena] mitral stenosis?

22:13:58 [Step_1] AV/PV regurg because of volume overload of ventricles (hypertropy/dialation) is the correct answer.

22:14:50 [Step_1] what gives a machinery murmur?

22:14:57 [sanya] PDA

22:15:01 [Lorena] ok

22:15:05 [Lorena] PDA

22:15:08 [merjo13] PDA

22:15:19 [jwls29] pda

22:15:22 [zeda] most common valvular heart dis. in U.S.?

22:15:28 [crusher] ok good step1....do you after S2 means (aotic and pul valves involve)

22:15:38 [Step_1] yes a PDA gives machinery murmur....mneumonic is a "PDA (palm pilot) is a machine"

22:15:39 [sanya] What direction is the flow of blood in PDA

22:15:43 [crusher] vsd

22:15:54 [merjo13] VSD

22:15:55 [Lorena] agree with crusher

22:15:58 [zeda] mitral valve prolapse

22:16:04 [merjo13] Aorta to pulm

22:16:15 [jwls29] agree with lorena and crusher

22:16:16 [zeda] especially in young women

22:16:17 [sanya] VSD you get a holosystolic or pan sys murmur

22:16:34 [Lorena] ops, you said valvular

22:16:35 [crusher] holosystolic

22:17:07 [merjo13] PSM

22:17:22 [sanya] merjo you're right

22:17:30 [zeda] middiastolic click followed by a late sys. murmur...Dx?

22:17:37 [merjo13] Thanks

22:17:46 [crusher] MVP

22:18:01 [zeda] right....mitral valve prolapse

22:18:29 [Step_1] MVP...agree

22:18:43 [Lorena] yes

22:18:55 [Step_1] what about opening snap?

22:19:14 [Lorena] mitras stenosis

22:19:19 [crusher] MS??

22:19:22 [merjo13] Occurs in MS

22:19:30 [Step_1] S-nap is S-tenosis

22:19:44 [zeda] what is nonbacterial thrombotic endocarditis?

22:20:05 [sanya] What will happen to the murmur in idopathic hypertropic subaortic stenosis when the patient is lying down

22:20:10 [jwls29] a mnemonic that helps me remember what is where is mr gluteal

22:20:11 [merjo13] occurs in SLE

22:20:36 [jwls29] mitral regurg aortic stenosis in systole

22:21:07 [Step_1] Liebman sack vegs in SLE

22:21:14 [zeda] friable,sterile emboli c/by hypercoagulable states

22:21:28 [merjo13] OOps...sorry

22:21:48 [zeda] gluteal. with DIC and adenoCA of pancreas

22:21:50 kokushubila enters this room

22:22:10 [crusher] hi koku

22:22:12 [Lorena] hi koku

22:22:15 [kokushubila] Hellooo everybody!

22:22:23 [Step_1] hi kiku

22:22:31 [zeda] hi koku

22:22:32 [jwls29] hi

22:22:34 [sanya] Hi Koks

22:23:14 [crusher] i gotta go>>guys

22:23:28 [crusher] see u later..may be

22:23:34 [jwls29] bye crusher

22:23:38 [sanya] why so soon crusher?

22:23:39 [Lorena] thank you crush

22:23:43 [zeda] which kind of murmur present in PDA?

22:23:53 [Step_1] bye crusher...thanks for the great questions

22:23:54 [Lorena] what do you mean maybe?

22:24:04 [merjo13] machinery murmur

22:24:13 [crusher] my movers r coming t.m so have piles of clothes n stuff to set

22:24:14 [Lorena] described as a machinery murmur

22:24:24 [zeda] YES...HARSH WAXING AND WANING

22:24:28 [crusher] anyone live in dallas???

22:24:29 [Step_1] machinery murmur in PDA because a "PDA (handheld) is a machine"

22:24:36 [zeda] MACHINERY MURMUR

22:24:46 [zeda] NICE STEP1

22:24:53 [sanya] Oh Ok bye see ya next week!

22:25:00 [Step_1]

22:25:08 [Step_1] abrupt onset of severe back pain, hypotension and pusatile mass are triad for what?

22:25:12 [Lorena] see you crush next week crush, bye

22:25:40 [zeda] bye crusher

22:25:41 [merjo13] Aneurysm rupture

22:25:44 [jwls29] aortic aneurysm?

22:26:01 [Step_1] thats the rupture triad for abdominal aortic aneurism....good job

22:26:16 [sanya] abdominal aortic anuerysm rupture

22:26:43 [Step_1] MI in a child is the buzz word for what dz?

22:27:05 [sanya] Kawasaki's

22:27:18 [zeda] Aschoff bodies in the myocardium are pathognomic for what?

22:27:28 [Lorena] agree

22:27:34 [Step_1] Kawasaki dz is MCC of acute MI in children....great sanya

22:27:36 [merjo13] Rheumatic fever

22:27:39 [sanya] Rheumatic carditis

22:27:41 [Lorena] aschoff bodies are dx for rheumatic fever

22:27:47 [jwls29] rheumatic fever

22:27:51 [zeda] right sanya

22:27:52 [Step_1] rheumatic fever

22:28:05 [sanya] thanks step1

22:28:08 [zeda] s/s?

22:28:33 [Lorena] jones criteria

22:28:55 [jwls29] arthralgia

22:28:57 [merjo13] 2 major 1 minor or vice versa

22:28:58 [jwls29] carditis

22:29:00 [sanya] subcutanoeus nodules, pericarditis, arthritis, chorea, erythema marginatum

22:29:03 [Lorena] arthritis, carditis, rheumatic nodules, erythema marginatum amd chorea are the major ones

22:29:16 [jwls29] nodules

22:29:16 [sanya] SPACE

22:29:19 [jwls29] sydenhan chorea

22:29:26 [Step_1] arthralgias, fever, elevated ESR or c reative protein, prolonged PR interval, erythema marginatum

22:29:52 [zeda] migratory polyarthritis,erythma margi.,subcut. nodules,pancreatitis

22:29:56 [Step_1] polyarthritis

22:30:05 [Lorena] minor are leukocytosis, fever, ESR?CRP increased, raised PR, arthralgia

22:30:41 [zeda] right

22:30:52 [sanya] What will happen to the murmur in idopathic hypertropic subaortic stenosis when the patient is lying down

22:31:35 [zeda] sequela of ac. rheumatic fever?

22:31:58 [jwls29] mitral valve stenosis

22:32:11 [Lorena] mitral stenosis and CHF , endocarditis

22:32:32 [Lorena] what is the answer to your q's sanya?

22:32:43 [merjo13] MS ,IE

22:32:54 [zeda] also..fish mouth deformity

22:33:07 [sanya] normally the other murmurs like MS or AS will increase because of increase return of blood to the heart on lying down so flow across the stenotic valve but in IHSS the murmur intensity decreases

22:33:32 [Lorena] thank you

22:33:35 [Step_1] sinusitis, saddle nose deformity, recurrent pneumonia, c-ANCA.....what dz?

22:34:00 [merjo13] Cong sypilis

22:34:02 [sanya] Wegenes granulomatosis

22:34:03 [kokushubila] Didn't know that Sanya Thank you

22:34:09 [Lorena] wegener disease

22:34:27 [sanya] you're welcome

22:34:45 [Step_1] wegeners granulomatosis is correct. anytime you see kidney and resp with c-anca is a dead give away....good sanya

22:34:52 [Step_1] and lorena

22:35:07 [jwls29] saddle nose is in wegener's?

22:35:08 [Step_1] treatment?

22:35:25 [Lorena] cyclophosphamide

22:35:29 [sanya] cause destruction of nasal cartilage

22:35:38 [Step_1] wegeners is the MCC of saddle nose deformity according to goljan

22:36:02 [jwls29] ok

22:36:08 [Step_1] cyclophospahmide is correct. bonus...what side effect and how to prevent?

22:36:11 [jwls29] i thought saddle nose was syphyllis

22:36:19 [jwls29] i guess i need to listen to his lectures

22:36:29 [sanya] hemorrhagic cystitis

22:36:55 [Lorena] dont know

22:37:01 [jwls29] agree with sanya

22:37:12 [Step_1]>[jwls29] i think syphillis too

22:37:19 [Step_1] cyclophosphamide causes hemorragic cystitis and prevented with Mesna....good

22:37:46 [Lorena] what is chrug strauss syndrome?

22:37:58 [jwls29] so in both?

22:38:00 [Lorena] Churg Strauss ..sorry

22:38:21 [jwls29] vasculitis with granulomas and eosinophilia

22:38:22 [sanya] its associated with asthma

22:38:36 [jwls29] assoc with asthma

22:38:41 [kokushubila] Vasculitis, Esinophilia , Asthma a combination of these-Churg ...

22:38:43 [Step_1] C-yclophoshamide remembered because of C-ANCA. the P-ANCA on the other hand is P-olyarteritis nodosa

22:38:49 [Lorena] v good

22:38:54 [zeda] small vess. vasculitis involving skin,lung,heart vess

22:39:11 [Step_1] agree

22:39:17 [sanya] I will be back in 10 minutes guys

22:39:29 [Step_1] ok sanya

22:39:30 [Lorena] mean dif between Churg and PAN?

22:39:49 [zeda] p-ANCA antibod. r present

22:40:04 [jwls29] pan does not involve lung

22:40:16 [jwls29] and p-anca instead of c-anca

22:40:18 [kokushubila] In Churg -you have Asthma

22:40:29 [Lorena] yes!

22:40:47 [Lorena] PAN involves any organ EXCEPT lung

22:41:13 [Lorena] and in Churg , meanly the lung is involved: asthma, etc

22:41:27 [Lorena] and the abs...good job

22:41:45 [jwls29] what antigen is positive in 30%

22:41:45 [Step_1] we should probably move to respiratory soon

22:42:00 [zeda] what r X-Linked bleeding disorders?

22:42:02 [Step_1] HBV

22:42:14 [jwls29] HBsAg

22:42:15 [jwls29] yes

22:42:16 [Lorena] HBs ag

22:42:26 [jwls29] hemophilia

22:42:28 [Step_1] hemophilia

22:42:35 [Lorena] hemophilia

22:42:49 [zeda] right..factor 8 and 9 defi.

22:43:24 [Step_1] which one for hemophilia A or B, 8 or 9?

22:43:25 [Lorena] lab in hemophilia A ?

22:43:47 [Lorena] hemophilia A is 8 , B is 9

22:43:52 [zeda] prolong pyy but normal bt,plt. count and pt in both

22:44:00 [jwls29] agree with lorena

22:44:12 [Step_1] 8=A and 9=B ....thankfully in order

22:44:13 [zeda] prolonged ptt

22:44:36 [Step_1] prolonged PTT normal PT and BT

22:44:54 [jwls29] agree

22:44:57 [zeda] right

22:45:02 [Lorena] yes

22:45:06 [Lorena]

22:45:41 [Lorena] and in VOn Willebrand disease?

22:46:34 [Step_1] increase BT, normal PT, increased PTT, low ristocetin cofactor assay

22:47:02 [Lorena] excellent

22:47:16 [Step_1] inc PT, PTT with low PLTs and D-Dimer present....what dx? that treatment?

22:47:31 [zeda] its a most common hereditary bleeding disorder

22:47:40 neurodoctor_75 exits from this room

22:47:45 neurodoctor_75 enters this room

22:48:16 [Lorena] DIC?

22:48:34 [Step_1] DIC, treatment is heparin because prevents consumption of coagulation factors

22:48:36 [Lorena] life support and treat underlying condition

22:48:42 [jwls29] DIC

22:48:46 [zeda] DIC

22:48:51 [jwls29] tx underlying condition

22:49:36 [Step_1] D-dimer is the buzz word, but also might see oozing of blood maybe post delivery

22:50:03 [Lorena] ok

22:50:15 [zeda] Histological presentation of ARDS?

22:50:16 [Step_1] should we do some respiratory path?

22:51:10 [jwls29] loss of pneumocytes

22:51:15 [Lorena] edema, inflamation

22:51:16 [zeda] characterized by intra-alveolar hyaline membranes

22:51:17 [Step_1] neutropil related injury with destruction of type 2 pneumocytes

22:51:19 [jwls29] inflammation

22:51:28 [Lorena] hyaline mebrane

22:51:33 [jwls29] i was missing edema

22:52:14 [Step_1] most commont cause of ARDS?

22:52:30 [jwls29] shock?

22:52:37 [Lorena] septic shock

22:52:50 [Step_1] endotoxic shock is MCC....good job

22:53:14 [zeda] sepsis,infection,aspiration and trauma

22:54:03 [Step_1] according to goljan, any child on exam with nasal polyps is assumed to have what dz?

22:54:51 [Step_1] wasn't actually in notes, but mentioned a couple of times in audio...the ans is CF

22:55:16 [jwls29] really????

22:55:29 [neurodoctor_75] why cf with the nasal polyps.

22:55:42 [Lorena] interessting

22:55:50 [Step_1] just for test.....not real life.

22:55:55 [neurodoctor_75] mean the pathogenesis

22:55:57 [Step_1] at least according to him

22:56:15 [zeda] what is Reid Index?

22:57:01 [Step_1] The ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and cartilage

22:57:01 [jwls29] it is the ratio of the mucus glands in the lungs

22:57:30 [zeda] Reid index is a ratio of the thickness of mucous gland to the thickness of bronchial wall

22:57:50 [zeda] increased Reid Index suggestive of what?

22:58:04 [Step_1] chronic bronchitis

22:58:08 [jwls29] chronic bronchitis

22:58:16 [zeda] yes

22:58:21 [zeda] s/s?

22:58:24 [Step_1] obstructive diseases

22:58:33 [Lorena] makes sence

22:59:15 [Lorena] cough, dyspnea, increased risk for infections

22:59:36 [Step_1] Blue Bloater, so cyanotic due to resp acidosis, obese

23:00:02 [Lorena] i wonder why they gain weight...

23:00:19 [Step_1] B-lue B-loater is B-ronchitis

23:00:25 [zeda] this is cyanosis resulting from severe hypoxia

23:01:20 [zeda] chronic bronchitis

23:02:01 [kokushubila] Pink Puffers?

23:02:14 [zeda] emphysema

23:02:23 [Step_1] cant find the reason for the obesity, but they seem to usually be obese and cyanotic vs the pink puffers that have emphsema and are typically think

23:02:57 [Lorena] ok thanks

23:03:03 [zeda] pink puffers overventilates

23:03:51 [Step_1] alpha 1 antitrypsin deficiency gives what type of emphysema? centrilobular or panacinar?

23:04:21 [Lorena] panacinar

23:04:31 [jwls29] panacinar

23:04:36 [Step_1] panacinar...that was a q.bank question....good job

23:04:41 [zeda] pan

23:04:57 [Lorena] centrilobular si asso with smoking

23:05:25 [Step_1] yes, agree

23:05:51 [jwls29] what is the only cancer of the lung treated with chemo instead of with surgery?

23:06:42 [Lorena] small cell ca?

23:06:49 [jwls29] yes

23:06:54 [zeda] small cell?

23:07:26 [Lorena] 2 ca associated with smoking?

23:07:43 [jwls29] small and squamous

23:07:49 [zeda] What is Ghon complex?

23:07:49 [Step_1] squamous and small cell cancers

23:08:01 [Lorena] yes

23:08:09 [Step_1]>[jwls29] what is the answer?

23:08:15 [kokushubila] Adeno not associated with smoking

23:08:27 [Step_1]>[zeda] seen in primary TB

23:08:38 [zeda] yes

23:08:44 [zeda] and in sec.?

23:08:48 [kokushubila] ????? I think I am wrong!

23:09:04 [jwls29] small cell cancer treated with chemo the rest are treated with surgery

23:09:06 [zeda] cavitary lesions in lung apices

23:09:15 [Lorena] you are right koku

23:09:20 [Step_1] adeno is the MC primary lung cancer in both smokers and nonsmokers

23:09:48 [Step_1] i think she meant which is exclusively seen in smokers....right?

23:10:33 [Lorena] yes, and adeno is less associated than squamous and small cell

23:10:37 [kokushubila] Ok got u, And Bronchioalveolar Ca is the only one which is not asso.with smoke , Right?

23:10:53 [Lorena] exactly

23:10:53 [Step_1] i agree

23:10:59 [Step_1] roofer for 15 yrs and smoker for 10 yrs greatest risk for what? primary lung cancer or mesothelioma?

23:11:12 [zeda] risk factors for CA colon?

23:11:17 [kokushubila] Lung Cancer?

23:11:21 [jwls29] lung cancer?

23:11:48 [Lorena] lung ca

23:11:50 [jwls29] fatty diet,low fiber

23:11:56 [Step_1] mesothelioma has no smoking relationship, but pt would die from primary lung cancer before getting mesothelioma because takes 20 to 30 yrs to develop

23:12:21 [jwls29] good question,step_1

23:12:21 [Lorena] adenomatous poliposis of the colon

23:12:48 [Step_1] thanks

23:13:01 [Step_1] from goljan so i cant take credit

23:13:16 [jwls29] lol

23:13:27 [Step_1]

23:13:31 [kokushubila] Main complications of Lung Ca ?

23:13:36 [Lorena] also when they give you a patient with exposure to asbestos and ask what cancer...dont jump tommesothelioma

23:13:50 [jwls29] why?

23:13:59 [Lorena] bronchogenic cancer is more frequent

23:14:17 [jwls29] ok

23:14:36 [Step_1] interesting....thanks

23:14:45 [jwls29] complications of lung cancer would be mets

23:15:01 [Lorena] unless yo donta have bronchogenic ca as a choice

23:15:05 [jwls29] to the adrenals in 50%

23:16:51 [sanya] Which Ca metastasizes most commonly to the liver

23:17:58 [Step_1] colorectal?

23:18:22 [Step_1] no never mind that answer

23:18:32 [kokushubila] SPHERE of Complications-Superior vena cava syndrome,Pancoats tumor,Horner's syndrome,Endocrine(paraneoplastic),Recurrent Laryngeal Syndrome(hoarseness).Effusions(Pleural, Pericardial) MUST KNOW these complications of Lung Ca

23:18:38 [sanya] 1st lung then colon

23:18:42 [jwls29] i don't know this one

23:18:59 [Lorena] thanks kokush

23:19:01 [jwls29] thank you

23:19:20 [Step_1] thanks kokush

23:19:34 [Step_1] and thanks sanya

23:19:44 [Step_1] tall thin male (or scuba diver) presents with sudden onset of pleuritic type chest pain, tympanitic percussion not, absent breath sounds, elevation of diaphram, trachea shifted. what dx?

23:20:02 [kokushubila] Thanks to F A !!

23:20:07 [Lorena] pneumothorax

23:20:14 [sanya] pnuemothorax

23:20:21 [jwls29] pneumothorax

23:20:36 [Lorena] spontaneous in thin, tall people

23:20:46 [kokushubila] U r welcome!

23:20:55 [Step_1] spontaneous pneumothorax often caused by rupture of subpleural bullae in apex of lung. seen in marfans and scuba.

23:21:02 [Step_1] good job

23:21:26 [Step_1] so i guess we'll do some neoplasia

23:21:53 [Lorena] yes

23:22:01 [jwls29] ok

23:22:17 [jwls29] i have a hard time with the oncogenes

23:22:28 [kokushubila] Wht's the Treatment of Neonatal Respiratory Distress Syndrome?

23:22:34 [jwls29] can't remember any except for the most obvious ones

23:22:40 [Lorena] did you check the neumonic i posted to remember them?

23:22:55 [jwls29] no

23:23:00 [jwls29] haven't seen it

23:23:04 [jwls29] on the forum?

23:23:11 [Step_1] real question (and q.bank too) asked about pt described with B cell follicular lyphoma and asked what caused it> choices were t8,14 , bcl-2 overexpression, and more?

23:23:19 [sanya] surfactant

23:23:46 [Lorena] t8, 14?

23:23:50 [jwls29] and oxygen

23:23:52 [Step_1] PEEP and O2

23:24:07 [sanya] bcl2 causing the apoptosis gene to be inactivated

23:24:16 [jwls29] i'm with lorena on that one

23:25:15 [sanya] t8,14 is Burkkits lymphoma, right

23:25:18 [Step_1] this one got me because I always mix up t 8;14 and t 14;18. the former is Burkitts and the latter is B cell follicular. since t 14;18 was not an option, it is the overexpression of bcl 2

23:25:39 [Lorena] wow

23:25:43 [jwls29] i always confuse them

23:26:03 [Lorena] me too

23:26:13 [Step_1] i think the boards know that we confuse them often, so be prepared

23:26:21 [jwls29] yup

23:26:23 [Lorena] thanks step

23:27:53 [Step_1] bilateral hearing loss dealing with inactivation of NF1....is this with chrom 17 or 22 and why

23:28:14 [Lorena] 17

23:28:14 [jwls29] 17

23:28:23 [sanya] 17

23:28:24 [jwls29] schwanomma

23:28:42 [jwls29] or is it bilateral acoustic neuroma

23:28:44 [Lorena] neurofibromas

23:28:46 [Step_1] Bi-lateral (2 sides) will be NF-2, so chom 22

23:29:01 [Step_1] another tricky one

23:29:03 Parmish enters this room

23:29:30 [Step_1] but good mneumoic is the 2 for BI lateral and 22

23:29:32 [sanya] retinoblastoma gene is it a tumor supressor gene or proto oncogene

23:29:48 [Lorena] tumor supresro gene

23:29:52 [Step_1] oops, i put NF1 in the question....my mistake

23:30:03 [jwls29] yeah i was confused

23:30:03 [Step_1] that would be 17....sorry

23:30:11 [jwls29] that's why i said 17

23:30:24 [sanya] that's OK

23:30:26 [jwls29] but i knew that nf2 was on chrom 22

23:30:28 [Lorena] yes, i understand now

23:30:35 [Step_1] i meant to put NF gene....sorry...

23:30:36 [jwls29] bilat hearing loss

23:30:42 [jwls29] cool

23:30:59 [jwls29] it's ok

23:31:40 [Step_1] long day of studying will have strange effects

23:31:45 [jwls29] lol

23:32:02 [Lorena] lol

23:32:56 [Step_1]>[sanya] is it a suppressor gene?

23:33:06 [Lorena] i have to go guys

23:33:08 [jwls29] how long do you guys usually stay?

23:33:13 [sanya] yes step1

23:33:33 [Step_1] thanks for the great chat again lorena

23:33:46 [Lorena] i wont be able to attend next chat so i will see you on wednesday

23:34:10 [jwls29] bye lorena...thanks

23:34:11 [sanya] bye lorena

23:34:22 [Lorena] bye

23:34:25 [kokushubila] Bye Lor , Enjoy your studies

23:34:35 [Step_1] bye lorena...we'll miss ya

23:35:29 [Step_1]>[jwls29] usually no longer than about 12 eastern (3 hrs). i think we're just about rapping things up with neoplasia

23:35:53 [jwls29] ok

23:36:07 [jwls29] so we meet again on saturday at the same time

23:36:15 [jwls29] ?

23:36:26 [Step_1] every wed and sat at 9pm eastern

23:36:56 [Step_1] just a couple more high yield things and we'll wrap up in next 10 mins....what do you say?

23:37:11 [jwls29] wonderful...so glad i found this group. Since I study alone I never know how much I'm retaining

23:37:17 [jwls29] that would be fine

23:37:22 [sanya] fine with me

23:37:50 [sanya] setp1 when is your exam

23:38:01 [Step_1] most of the benefit is that you want to prepare and stay on schedule with the group....i love that i found this group too

23:38:02 [sanya] sorry step1

23:38:17 [Step_1] mine is coming up next week

23:38:26 [jwls29] i've missed alot though

23:38:32 [jwls29] that makes me sad

23:38:37 [neurodoctor_75] good luck

23:38:47 [sanya] Wow , I'm sure you're going to ace it

23:38:50 [jwls29] oh wow

23:38:56 [jwls29] you'll do great

23:39:00 [Step_1] if things go as planned, the group can recycle the schedule and get newcomers all the time

23:39:21 [neurodoctor_75] good idea

23:39:22 [jwls29] oh good

23:39:30 [jwls29] that would be wonderful

23:39:31 [Step_1] i dont know about that....i'm very nervous about it...but i'll never feel ready so i'm just going to go for it

23:40:03 [sanya] yeah i felt the same for step2 don't worry!

23:40:53 [Step_1] i'll make sure to give a good experience for you all afterwards that will hopefully help

23:41:19 [Step_1] most common cancers in decreasing order. first list incidence in males (top 3)

23:41:23 [sanya] Thanks so much!

23:41:43 [sanya] prostate, lung colon

23:41:56 [jwls29] prostate, lung,colon

23:42:12 [Step_1] by the way, i hope that everyone got the 100 pg goljan hy notes in the download area

23:42:13 [sanya] brast, lung , colon females

23:42:27 [Step_1] prostate, lung, colorectal is right. what about females

23:42:31 [jwls29] agree with sanya

23:42:42 [jwls29] i just downloaded it yesterday

23:42:52 [Step_1] sanya is correct....good

23:42:55 [jwls29] i'm going to have to listen to his lectures

23:43:15 [Step_1] what about mortalities for men and women separately?

23:43:22 [sanya] Oh yes, that was so kind

23:43:22 kokushubila enters this room

23:43:35 [Step_1]>[jwls29] highly recommended....i love his lectures

23:43:42 [jwls29]

23:43:51 [sanya] lung, prostate, colon men

23:43:58 [jwls29] mortalities are lung in both

23:44:07 [sanya] lung, breast, colon women

23:44:18 [jwls29] breast in women prostate in men

23:44:27 [jwls29] colon third in both

23:44:48 [jwls29] thank u very very much

23:45:04 [jwls29] its hard for me to listen to his lectures since i don't have his notes

23:45:15 [jwls29] my mind wanders

23:45:18 [Step_1] now what about the 2nd most common cause of cancer death in total population....trick question

23:45:25 [sanya] Really nice of you guys to do it

23:45:52 [Step_1] i think the notes are important for his lectures, although he doesn't follw the order

23:46:20 [jwls29] would the 100 pgs be good to listen to with the lectures?

23:46:38 [jwls29] would the 2d most common be colon?

23:47:04 [Step_1] colorectal is the 2nd most common in both men and women combined because men dont get breat cancer very often and women dont have prostates....trick question

23:47:47 [Step_1] the 100 pgs are a summary and not really related too much for the lectures. good high yield info for studying after his lectures

23:48:42 [Step_1] another real question described a SE china person most likely to have what type of cancer secondary to EBV?

23:49:14 [neurodoctor_75] lung?

23:49:29 [kokushubila] Nasopharyngeal Ca

23:49:30 [sanya] nasopharyngeal ca

23:49:43 [jwls29] nasopharyngeal??

23:49:46 [Step_1] the answer is nasopharyngeal carcinoma for SE China secondary to EBV.....good job....one more from me

23:50:00 [Step_1] MC cancer in Japan? why?

23:50:13 [jwls29] gastric

23:50:13 [sanya] gastric adeno CA

23:50:13 [neurodoctor_75] gastric

23:50:26 [jwls29] lots of smoked food

23:50:29 [sanya] eating smoked foods, nitrosamines

23:50:33 [jwls29] nitrites

23:50:51 [Step_1] stomach carcinoma due to smoked products and preservatives....excellent!

23:51:17 [Step_1] ok, i think i'll call it a night....we went over alot

23:51:35 [jwls29] yeah me too

23:51:38 [jwls29] i'm tired

23:51:48 [jwls29] thank you all so much for making me feel welcomed

23:51:49 [sanya] Ok then see you all on Saturday, Bye!

23:51:54 [jwls29] and for the great questions

23:52:03 [jwls29] see you all on saturday

23:52:06 [kokushubila] Guys I have to go,THANK YOU

23:52:10 [jwls29] have a great night

23:52:12 [Step_1] so the remainder of path for sat night. i'll see everyone on sat and maybe some of you in the forum in between

23:52:26 [neurodoctor_75] see u all

23:52:35 [kokushubila] Have a nice study , God bless you

23:52:39 [jwls29] what are the topics for sat?

23:53:32 [Step_1] there is an announcement posted on the step 1 forum, but it is the remainder of path (gi, cns, etc)

23:53:41 [jwls29] thanks

23:53:49 [jwls29] have a good night, everybody

23:53:50 [Step_1] :flyaway

23:54:06 [Step_1] oops