Pathology chat 2 (GI, hepato, renal, etc)

[Anonymous]

21:07:49 [Step_1] what is the most common motor disorder of esophagus?

21:08:11 [Step_1] hint....has to do with LES shincter

21:08:14 [zeda] Rt. lower quadrant pain,nausea,fever, and an elevated WBC...Dx?

21:08:42 [Step_1] appendicitis?

21:08:52 [jwls29] step....achalasia

21:09:00 [zeda] Achalasia

21:09:04 [jwls29] zeda...appendicitis?

21:09:11 [Step_1] yes jwls and zeda...very good

21:09:16 [zeda] yes

21:09:18 [zeda] right

21:10:06 [Step_1] what usually causes barretts esophagus and what kind of cancer can it lead to ?

21:10:29 [jwls29] Gerd is a cause

21:11:10 [jwls29] i think the ca is squamous

21:11:13 [zeda] esophageal adenoca

21:11:18 wisdom enters this room

21:11:27 [perch30] adenocarcinoma

21:11:32 [Step_1] BARRett's = B-ecomes A-denocarcinoma, R-esults from R-eflux

21:11:46 [Step_1] hi wisdom

21:11:51 [jwls29] cool

21:11:58 [zeda] nice

21:11:59 [jwls29] very good way to remember it

21:12:12 [wisdom] hi

21:12:30 [wisdom] waiting for next question

21:12:41 [Step_1] with peptic ulcer disease, how do you know if gastric or duadenal?

21:13:09 [Step_1] pain Greater with meals vs. Decreases with meals...which one is which?

21:13:14 [wisdom] pain after meal or not

21:13:47 [jwls29] duodenal is 1-3 hours after food

21:13:57 [wisdom] pain after meal is gastric

21:14:29 [Step_1] wisdom, you might want to choose brighter color from rainbow on right

21:14:31 [jwls29] relieved by eating

21:14:36 [Step_1] G-reater = G-astric and D-ecreased = D-uodenal

21:15:12 [Step_1] pain Greater vs Decreased with meals

21:15:34 [wisdom] ok

21:16:11 [jwls29] which ulcer is associated with O blood type?

21:16:28 [wisdom] gastric

21:16:37 [zeda] most common liver dis. in US?

21:16:59 [Step_1] duodenal

21:17:11 [jwls29] it's duodenal

21:17:19 [zeda] alcoholic liv. dis

21:17:33 [Step_1] hepatitis?

21:18:06 [Step_1] nevermind, i'd guess acoholic liver diz too

21:18:37 [zeda] how it presents?

21:19:17 [Step_1] newborn has projectile vomiting at 2 4 wks after birth of non bile stained fluid....dx?increase in AST to ALT

21:19:21 [jwls29] cirrhosis

21:19:40 [Step_1] oops...thats two sentences sorry

21:19:54 [zeda] Mallory bodies,neutrophilic infiltrate,and hepatocyte swelling and necrosis

21:20:26 [wisdom] alcoholic hapatitis

21:20:45 [zeda] yes

21:20:46 [wisdom] A HEPATITIS

21:21:08 [zeda] what are mallory bodies?

21:21:40 [zeda] step1 ...pl. give your ans

21:21:47 [perch30] I have to go, i'm realy sorry, i can't continue. You have a fruitful night, guys. Hope to join you later

21:22:04 [jwls29] bye,perch

21:22:16 [wisdom] BYE

21:22:45 [Step_1] bye

21:23:00 [Step_1] intermiediate fillaments

21:24:30 [Step_1] newborn has projectile vomiting at 2 4 wks after birth of non bile stained fluid....dx? the ans is pyloric stenosis because non bile and a couple of weeks after birth. what if said at birth and has bile stained projectile vomitting?

21:24:51 nne enters this room

21:24:58 [jwls29] duodenal atresia

21:25:16 [zeda] thanks

21:25:27 [zeda] pri. malig. of liver (most common)?

21:25:47 [Step_1] duodenal atresia is at birth and has bile stained projectile vomitting. associated with down syndrome and double bubble sign (notice all the D's)

21:27:46 [zeda] hepatocellular CA asso. with he. B infection

21:27:53 [Step_1] lung cancer is the mc metastisis...not sure about primary

21:27:57 [jwls29] you give the best tips, step 1

21:27:57 [zeda] s bronze diabetes?

21:28:14 [wisdom] HEMOCHROMATOSIS

21:28:32 [Step_1] thanks...i live by mneumonics

21:28:34 [jwls29] agree with wisdom

21:28:56 [zeda] yes....iron absorption defect leading to accumulation

21:29:18 [zeda] presents as triad of cirrhosis,and dm

21:29:50 [zeda] sorry..+skin pigmentation

21:30:17 [Step_1] in wilsons dz, is total copper increased or decreased...trick question?

21:30:44 [wisdom] increased

21:30:48 [jwls29] increased?

21:31:12 [wisdom] ceruloplasmine is decreased

21:31:14 [zeda] copper deposite in liver

21:31:18 [Step_1] the total copper is decreased, but the free copper (the one that counts) is the one thats increased. most think it would be total increased...but its not....hence the trick

21:31:43 [zeda] also in cornea

21:31:48 [wisdom] thanks

21:31:58 [jwls29] good one

21:32:01 [Step_1] thats right wisdom, the ceruloplasmine is decreased

21:32:09 [zeda] oh...nice info.

21:32:13 [Step_1] what is the treatment?

21:32:40 [wisdom] penicillamine

21:33:50 [Step_1] the mneumonic for wilsons is ABCD, which is Abnormal movements, Basal Ganglia, Copper Ceruloplasmin Corneal deposits, Dementia

21:33:52 [Step_1] penicillamine is tx.

21:34:01 [Step_1] good job wisdom

21:34:57 [Step_1] in hemocromatosis, is iron increased or decr? what about TIBC and ferratin?

21:35:44 [zeda] what is the characteristic histo. feature of childhood polycystic kid. dis.?

21:35:56 [jwls29] increades serum and ferratin

21:36:22 [Step_1] the iron is high, but all trapped in storage (ferratin). since its high, the body decreases the transferin production so decreased TIBC

21:36:43 [Step_1] ferritin is high and TIBC is low

21:36:46 [jwls29] ok

21:37:51 [Step_1] AR for childhood Polycystic kidney.

21:38:07 [wisdom] yes

21:38:55 [zeda] yes.....

21:38:58 [Step_1] gastric vs peptic ulcer...which one leads to malignancy?

21:39:40 [jwls29] gastric?

21:39:43 [zeda] the cysts are oriented in a radial faschion with their long axis at righ angles to the capsule

21:40:16 [jwls29] thank you,zeda

21:40:30 [Step_1] gastric can lead to cancer, so must biopsy to rule out cancer. no malignant potential with duodenal

21:40:32 [zeda] gastric

21:40:38 [Step_1] good jwls

21:40:51 [Step_1] and zeda

21:41:32 [Step_1] what is the name of syndeom that has malignant islet cell tumor secreting gastrin?

21:41:52 [zeda] what are the external manifestations of adult polycys. kid. dis.?

21:42:02 [jwls29] zollinger ellinson

21:42:08 [wisdom] zollinger ellison

21:42:25 [Step_1] ZE syndrome will have increase gastrin...good job

21:42:52 [jwls29] presents with htn,renal insuf, and hematuria

21:42:53 [wisdom] subarachnoid hemorrage as complication

21:42:58 [Step_1] associated with hypertension, berry aneurysm

21:43:07 [jwls29] at first it can be asymptomatic

21:43:17 [wisdom] good

21:44:15 [Step_1] RBC casts in urine is buzz word for what? nephrotic or nephritic?

21:44:36 [wisdom] nepritic

21:44:40 [zeda] nephritic

21:44:41 [jwls29] nephritic

21:44:48 [wisdom] nephritic

21:44:54 [Step_1] nephritic....good. what will be the casts seen in nephrotic?

21:45:17 [wisdom] fat oval cast

21:45:47 [zeda] which is the specific test for nephritic synd?

21:46:11 [Step_1] fatty casts seen in nephrotic....good. so which will have protein >3.5 gm/dL in 24hrs?

21:46:25 [jwls29] nephrotic

21:46:44 [wisdom] yes

21:47:28 [Step_1] both have proteinuria, but nephrotic has more with >3.5....good

21:47:57 [wisdom] agree

21:48:16 [jwls29] agree

21:48:28 [Step_1]>[zeda] test for nephritic....could that be to check for hematuria or RBC casts....not sure?

21:48:47 [zeda] immunofluoresence ( granular deposites of IgG,IgM,and C3 in glomerulus) and electron micro.( subepi. immune complex deposite)

21:49:24 [zeda] light micro. for red cell cast

21:49:52 [wisdom] streptoc glomerulonepritis

21:50:03 [zeda] what is the Tx?

21:50:11 [zeda] of nephritic

21:50:20 [Step_1] hint-if it ends in itis, its type 3 hypersens disorder...the exception is goodpastures which is type 2

21:50:33 [wisdom] prednisone

21:50:57 [zeda] conservative fluid management

21:51:43 [jwls29] agree with zeda

21:51:55 [wisdom] ok

21:52:25 [wisdom] good job zeda

21:52:35 [zeda] thanks

21:52:53 [Step_1] pt presents with abd pain radiating to back, weight loss, anorexia, migratory thrombophlebitis, pancreatic duct obstruction....dx?

21:53:14 [zeda] spike and dome appearence--??

21:53:16 [jwls29] cancer of head of pancreas?

21:53:20 [wisdom] trousseau syndrome

21:53:31 upwind66 enters this room

21:53:43 [wisdom] with ca pancreas

21:53:47 [Step_1] pancreatic adenocarcinoma

21:54:05 [zeda] pancreatic adenoca

21:54:32 [wisdom] agree

21:55:21 [Step_1] after stressfull life event, 30 yo man has diarrhea and blood per rectum. intestinal bx shows transmural inflammation...dx?

21:55:39 [jwls29] ulcerative colitis

21:56:09 [jwls29] no

21:56:17 [jwls29] i take that back

21:56:20 [jwls29] crohn's

21:56:37 [jwls29] ulcerative is limited to mucosa and submucosa

21:56:56 [Step_1] the diagnosis is chrons dz which is transmural as the give away...good job thinking it thru jwls

21:57:24 [Step_1] which of the two has fistula formations? which has skip lesions?

21:57:37 [wisdom] crohn'sd

21:57:53 [jwls29] crohn's has skip and fistulas

21:57:59 [Step_1] chrons for both....what is the tx?

21:58:24 [zeda] child presenting with palpable flank mass and hematuria---Dx?

21:58:53 [wisdom] wilm's tumor

21:59:06 [zeda] right

21:59:14 [jwls29] what is the tx, step?

21:59:18 [Step_1] agree

21:59:28 [Step_1] prednisone is tx

21:59:30 [jwls29] agree too

21:59:42 [jwls29] thanks

21:59:50 nne enters this room

22:00:00 [wisdom] agree

22:00:25 [nne] hi everyone, ihave had a rough time trying to log in

22:00:54 [Step_1] young man presents with mental deterioration and tremors. he has brown pigmentation in a ring around periphery of his cornea and altered LFTs. what tx should he receive?

22:00:57 [zeda] hi nne

22:01:01 [Step_1] hi nne

22:01:28 [wisdom] penicillamine

22:01:32 [jwls29] penicillimine?

22:01:40 [jwls29] can't spell today

22:01:44 [zeda] penicill.

22:01:47 [Step_1] penicillamine is the tx because its wilsons dz....good job

22:01:59 [wisdom] thanks

22:03:19 [Step_1] pt presents with flank mass, hematuria and pain....most likely dx with this triad?

22:03:40 [zeda] renal cell CA

22:04:22 [Step_1] thats right, renal cell CA known for that triad...good zeda

22:04:31 [zeda] histo-----clear cells containig glycogen and lipids

22:04:34 [wisdom] agree

22:04:45 [zeda] thanks

22:05:39 [wisdom] where

22:05:50 [Step_1] i gotta go early tonight....can someone else post the transcript when this is over?

22:06:51 [Step_1]>[wisdom] where what?

22:07:12 [zeda] good luck for your exam----so u will be not here on next chat?

22:07:28 [wisdom] is the histo is for renal cell ca

22:07:36 [Step_1] nope, but lorena will be here

22:07:45 [zeda] yes

22:07:50 [zeda] ok

22:07:53 [nne] goodluck. step 1

22:07:56 [Step_1] thanks for the good luck wish....i'll be needing it

22:08:11 [nne] how do we post this/

22:08:15 [jwls29] are you leaving?

22:08:20 [wisdom] good luck on ur exam

22:08:23 [zeda] I didn't finish patho. yet

22:08:46 [zeda] need to study more---so i msut leave now

22:08:46 [nne] you will get 99

22:09:03 [Step_1] i'll post the transcript up to this point, maybe whoever is left at the end can post the rest. i gotta go early, but the rest of you can finish with path....usually goes until 12 eastern

22:09:32 [jwls29] i'm on my way out, too

22:09:38 [nne] how do we post it

22:09:44 [jwls29] good luck, step 1

22:09:49 [Step_1] thanks nne, but i'd be just as happy with a 75

22:09:51 [jwls29] you'll do great

22:10:04 [wisdom] MEN TYPE 1 ?

22:10:21 [nne] are you an IMG

22:10:27 [zeda] Rest of it ---we can discuss on someother day?

22:10:40 [Step_1] thanks everyone....keep studying hard....i'll be sure to post my experience afterwards and will check in on everyone to help out afterwards.....good luck to all

22:10:56 [nne] becos if you are you won't want that step 1
22:11:10 [zeda] ok---hope to see u soon

22:11:12 [zeda] e

22:11:15 [wisdom] GIVE US FEEDBACK WHENEVER U HAVE TIME

22:11:37 [jwls29] goodnight all. I'll be back on weds

22:11:46 [jwls29] again, good luck, step 1

22:12:07 [wisdom] good luck again

22:12:07 [Step_1] thanks everyone....bye

22:12:11 [jwls29] bye

22:12:22 [nne] bye