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07-14-2004, 12:09 AM
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chat transcipt - Path July 13 (Environmental, vasc, cardio, resp.)
20:59:27 [jwls29] but i figured that since we always meet here i'd come here first
20:59:31 [jwls29] hi step 1 20:59:45 [GABA] hi step 1!! 21:00:01 [sanya] hi step1 21:00:03 [zeda] ya...in GENERAL ROOM ,but since here is no chat going on and everybody entered here,we can start chat here? 21:00:22 [jwls29] that's fine 21:00:36 [sanya] ok zeda 21:00:41 [zeda] so lets start from Environment patho? 21:00:50 [Step_1] i'll leave a message in the general chat room to let people know we're in here....be right back 21:00:53 [ayouh] sounds great 21:00:54 Step_1 exits from this room 21:01:00 [jwls29] ok 21:01:01 Step_1 exits from this room 21:01:20 crusher enters this room 21:01:28 [zeda] Pri. carcinogen present in tobacco?...and smokeless tobacco is harmful or not? 21:01:34 [crusher] hi everyone 21:01:41 [zeda]>[Step_1] Thanks step 1 21:01:50 [jwls29] smokeless tobacco is harmful 21:01:53 Step_1 enters this room 21:01:54 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite. 21:01:57 [crusher] it sure is carcinogen 21:01:59 [zeda] hi crusher 21:02:04 [ayouh] co ? 21:02:07 [sanya] hi crusher 21:02:18 [crusher] hi sanya 21:02:21 [zeda] ya...what is pri carcinogen in tobacco? 21:02:25 [Step_1] hi crusher 21:02:26 [crusher] hi zeda 21:02:51 [ayouh] cyanide ? 21:02:51 [crusher] Carbomonoixde 21:02:54 [jwls29] carbon monoxide, arsenic,forhaldehyde and nicotine is the addictive component 21:03:01 [crusher] hi step1 21:03:05 [zeda] ya... 21:03:21 [zeda] Polycyclic hydrocarbon is pri. 21:03:36 [zeda] nice jwls 21:03:46 [jwls29] thanx 21:04:10 [zeda] Why alcohol is more harmful for female? 21:04:18 [GABA] NNK 21:04:22 [ayouh] what is smokeless tobocaa ? chewing one ? 21:04:35 [zeda] ya chewing tobacco 21:04:43 [jwls29] yes,chewing tobacco is smokeless 21:04:52 [ayouh] ok thanks...just making sure.. 21:04:54 [zeda] can cause nicotine addiction an CA 21:04:59 [sanya] because of decreased aldehyde dehydrogenase in females therefore less metabolised and more levels which is toxic 21:05:21 [jwls29] agree with sanya 21:05:22 [zeda] RIGHT SANYA 21:05:40 [Step_1]>[zeda] i think because they can't metabolize as quickly due to dec in aldehyde dh 21:05:42 [zeda] What will happen in Aspirin overdose and why? 21:05:54 dia_huq enters this room 21:06:04 [zeda] hi dia 21:06:04 [jwls29] respiratory alkalosis and metabolic acidosis 21:06:18 [crusher] inc salicylic acid and it causes met acidosis 21:06:27 [crusher] hi dia 21:06:27 [dia_huq] hello everyone 21:06:30 [ayouh] ulcers, reye syn. in kids 21:06:34 [Step_1] mixed resp alk and met acidosis 21:06:45 [jwls29] hi dia 21:06:58 [sanya] hi dia 21:07:03 [Step_1] hi dia 21:07:13 [ayouh] vertigo and decresed hearing ... 21:07:53 [zeda] Gen. symptoms ( tinnitus,vertigo,confusion),acid-base disorders,Hyperthermia ( saliclates damage the inner mito. memb.,oxidative energy released as heat not as ATP, AND gastritis 21:07:55 [Step_1] uncouples oxidative phos 21:08:14 [sanya] uncouples oxidative phosphorylatoin and causes increased temp 21:08:18 [zeda] and fulminent hepatitis 21:08:47 [zeda] right 21:09:50 [zeda] Anhidrosis,delirium,seizures,hyperventilation,vol. depletion......Dx? 21:10:32 [ayouh] ach inh. poisoning ? 21:10:47 [zeda] Heat Stroke 21:10:54 [Step_1] delerium tremors?? 21:11:15 [sanya] anticholinergics 21:11:29 [sanya] OK 21:11:37 [crusher] vol depletion 21:11:37 [GABA] anticholinerg intox 21:11:40 [zeda] temp. exposure > 40 degrees centi.( >104 degree F ) 21:12:27 [zeda] Pt. dies with post-burn infection...sepsis c/by..? 21:12:41 [zeda] MC? 21:12:44 [jwls29] pseudomonas? 21:12:45 [ayouh] pseudomonas are. 21:12:46 [sanya] pseudomonas 21:12:52 [Step_1] pseudomonas 21:12:59 [crusher] cos of vol depletion 21:13:00 [dia_huq] Pseudomonas? 21:13:01 [zeda] right 21:13:37 [sanya] young female pt with painful liver enlargement and ascites what could be the drug be? 21:13:42 [zeda] Tum. asso. with Asbestosis? 21:14:05 [crusher] mesothiloma 21:14:09 [sanya] bronchogenic ca and mesothelioma 21:14:14 [ayouh] tylenol, suicide attempt ? 21:14:15 [jwls29] agree with crusher 21:14:24 [ayouh] mesothelioma 21:14:28 [GABA] meso 21:14:40 [zeda] ya. 21:15:21 [sanya] bud chiari syndrome seen with birth control pills 21:15:40 [jwls29] thank you sanya 21:15:44 [jwls29] good question 21:15:46 [sanya] hepatic vein thrombosis 21:15:55 [ayouh] wow...thanks.. 21:15:55 [zeda] Person inhaled CO,and found conc. is 10%....what will be the symptoms? 21:16:02 [sanya] y're welcome 21:16:07 [jwls29] headache 21:16:12 [sanya] no symptoms 21:16:20 [crusher] red ,hyperventila 21:16:32 [zeda] symptoms depend on conc.......so, this pt. will be asymptomatic 21:16:53 [ayouh] can you list sym. with conc. plz ? 21:16:59 [jwls29] at what concentration do they become sx? 21:17:08 [sanya] 30 with headache 21:17:10 [zeda] at 30%....pt will develop headache and shortness of breath on exertion 21:17:28 [zeda] at 50%.....loss of conciousnes 21:17:34 [sanya] 60 ead 21:17:35 [zeda] 60%....death 21:17:44 [sanya] dead 21:17:50 [ayouh] thanks 21:17:55 [zeda] ya. 21:17:58 [jwls29] thx 21:18:31 [zeda] Garlic -scented breath......which poisoning? 21:18:42 [sanya] Arsenic 21:18:44 [crusher] arsenic poi 21:18:46 [zeda] Arsenic 21:18:47 [jwls29] arsenic 21:18:49 [zeda] right 21:19:14 [zeda] most common metal poisoning? 21:19:26 [jwls29] if there is an electrical injury, which is worse,wet skin or dry skin and why? 21:19:26 [zeda] and characteristic? 21:19:29 [ayouh] lead? 21:19:35 [crusher] Pb 21:19:47 [ayouh] wet skin, water in conductor? 21:19:48 [GABA] lead 21:19:51 [sanya] lead 21:19:53 [ayouh] sorry is 21:20:05 [GABA] wet elctron duct 21:20:09 [crusher] wet skin cos more conduction 21:20:28 [jwls29] yes...wet skin decreases resistance which increases current 21:20:31 [zeda] lead poisoning....and characteristics are...basophilic stippling,peripheral neuropathy,lead lines in bones and abd. colic 21:20:51 [sanya] what is the cause of basophilic stipling 21:21:02 quizme2005 enters this room 21:21:14 [zeda] I think we should move on to VASCULAR PATHO. now? 21:21:21 [quizme2005] hi everyone 21:21:35 [Step_1] hi quizme 21:21:35 [ayouh] good idea 21:21:40 [ayouh] hi quiz 21:21:48 [jwls29] hi quiz...can u change your color?? 21:21:50 [dia_huq] today is patho?i thought it was behavioral science? 21:21:50 [zeda] hi quiz 21:21:51 [crusher] hi quize 21:22:10 [jwls29] tomorrow is ** 21:22:11 [dia_huq] oops sorry 21:22:21 [quizme2005] i just wanted to ask if everyone has WEb PREP kap-lan or need it? 21:22:32 [dia_huq] sorry 21:22:39 [jwls29] it's ok 21:22:46 [dia_huq] is this better 21:22:55 [zeda] thanks 21:22:57 [ayouh] thanks dia 21:22:59 [zeda] better 21:23:18 [Step_1] quizme, you might want to change your font color with the rainbow on the right so we can see the text better 21:23:29 [jwls29] i have it, quizme 21:23:33 [quizme2005] did thanks 21:23:33 [jwls29] thanks 21:23:35 [zeda] c/p of Arteriosclerosis? 21:23:36 [sanya] zeda lead poisoning causes microcytic anemia the cause of basophilic stipling is lead denatures the enzyme ribonuclease and it is the fragmented ribosomes that cause it 21:23:40 [quizme2005] oh ok jwls 21:23:53 [GABA] what about basophilic stippling??? 21:23:54 [sanya] atherosclerosis 21:23:56 [Step_1] thanks, much better 21:24:06 [sanya] which are the enzymes denatured in lead poisoning? 21:24:09 [jwls29] does everyone else have the web prep 21:24:28 [GABA] ty 21:24:32 [ayouh] ribosomal enzymes ? 21:24:38 [dia_huq] good luck with this session guys,gotta go study neuroanat for tomm.Join you in anat lecture as that is what we're learning now. 21:24:51 [dia_huq] have fun and study hard 21:25:05 [ayouh] where is ana. lecture ? 21:25:12 [Step_1] dia, are you in the 7 week course? 21:25:28 [dia_huq] i meant anatomy chat sorry 21:25:31 [dia_huq] yes 21:25:32 [Step_1] i mean the live course that is....from your post 21:25:37 [jwls29] d-aminolevulinic acid dehydratase and ferrochelatase 21:25:38 [dia_huq] just started 2 days ago 21:25:45 [quizme2005] anser sanya? 21:25:59 [sanya] YES JWLS ALSO WITH RIBONUCLEASE 21:26:14 [jwls29] ok 21:26:16 [quizme2005] um what do these enzymes do? 21:26:19 [jwls29] good luck dia 21:26:38 [jwls29] they are used in heme production 21:26:41 [sanya] they are denatured by lead 21:26:45 [dia_huq] thx see you all later 21:26:50 [Step_1] good luck with the course, hope to see you around here....maybe we can mirror your schedule to make it easier on you. 21:26:52 [quizme2005] later dia 21:27:15 [crusher] and lead is a co.factor 21:28:09 [zeda] bye dia,and make notes for chat ...i hope to see u again 21:28:18 [quizme2005] sanya what do these enzymes do and where is this information (cant find in the patho book?) 21:28:54 [ayouh] goljan i think 21:28:57 [sanya] it is is goljan notes and is pretty important for lead poisoning 21:29:05 [quizme2005] oh 21:29:06 [jwls29] i have it in my kap book 21:29:15 [zeda] ya..these info is from Goljan's manual 21:29:24 [quizme2005] ok thanks 21:29:33 [quizme2005] the 100 pg's one rite? 21:29:36 [ayouh] jwl, biochemistry book ? 21:29:55 [jwls29] no 21:30:01 [jwls29] in the path book by kap 21:30:05 [ayouh] patho ? 21:30:11 [jwls29] page 86, bottom margin 21:30:13 [sanya] which poisoning do you see oxalate crystals in urine 21:30:16 [quizme2005] really? 21:30:16 [jwls29] yes 21:30:22 [jwls29] uh huh 21:30:28 [jwls29] i have the 2002 version 21:30:34 [quizme2005] doh 21:30:36 [ayouh] oh my god !! 21:30:43 [jwls29] it says bridge to biochemistry 21:30:56 [ayouh] yeah i saw it... 21:31:04 [quizme2005] ur rite i skipped over that 21:31:18 [jwls29] lol 21:31:58 [quizme2005] sanya answer plez? 21:32:07 [jwls29] yes please sanya 21:32:10 [jwls29] can't find it 21:32:17 kokushubila enters this room 21:32:29 [Step_1] hi koku 21:32:29 [zeda] hi kokush 21:32:33 [quizme2005] hey koku 21:32:33 [jwls29] hi koku 21:32:38 [quizme2005] lol 21:32:42 [sanya] ethylene glycol, guys this is pretty important too 21:32:42 [crusher] ho koku 21:32:48 [kokushubila] Hello everybody! 21:32:58 [ayouh] ok..what about it ? 21:33:28 [quizme2005] i havent read goljan cuz i thought it was only <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10002441&type=3 &subid=0 >Kaplan</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 > but ill read it now 21:33:36 [quizme2005] whoops 21:33:45 [quizme2005] sorry 21:33:57 [sanya] that's the cause of oxalate crystals in urine, ayouh 21:34:10 [ayouh] oh.. 21:34:26 [zeda] what is the treatment for methyl alco. poisoning? 21:34:41 [Step_1]>[quizme2005] i think its kap lan for everything except path which is goljan 21:34:42 [quizme2005] ethyl alco 21:34:43 [sanya] yes it only k a p but since it was important I just mentioned it 21:34:47 [GABA] alcohol etthyl 21:34:52 [jwls29] ethyl alcohol 21:34:53 [quizme2005] Step_1> thanks 21:34:55 [crusher] etanol 21:34:55 [ayouh] ehtyl alcohol... 21:34:58 [sanya] ethanol 21:34:59 [ayouh] !!! 21:35:07 [ayouh] funny one..i love it.. 21:35:17 [quizme2005] sanya> sorry i was just asking 21:35:22 [jwls29] they compete for the same receptor 21:35:38 [zeda] yes 21:35:40 [sanya] that's Ok! 21:36:15 [jwls29] what type of nephropathy is seen in heroin abus? 21:36:18 [jwls29] abuse 21:36:30 [quizme2005] focal 21:36:39 [zeda] focal GN 21:36:40 [sanya] focal glomerular sclerosis 21:36:50 [jwls29] yup 21:36:52 [Step_1] focal segmental glomerulosclerosis 21:37:13 [sanya] what do you give as antidote 21:37:13 [jwls29] i've repeated renal a few times...hard for it to stick 21:37:27 [jwls29] for heroin? 21:37:35 [jwls29] nalaxone 21:37:36 [quizme2005] more herion? 21:37:39 [crusher] naloxone 21:37:49 [zeda] naloxone 21:37:50 [quizme2005] oh 21:37:52 [Step_1] naloxone 21:37:57 [sanya] yes 21:38:05 [zeda] an opiate antagonist 21:38:14 [ayouh] naloxone or heroin ? 21:38:16 [sanya] how does cyanide posisinig work 21:38:22 gurryaj enters this room 21:38:29 [sanya] sorrry poisoning 21:38:43 [jwls29] it inhibits complex IIII in the ETC 21:39:27 [jwls29] complex IIII=mitochondrial cytochrome oxidase 21:39:36 [GABA] inactivation of cytochrome oxidase 21:39:40 [zeda] Which one is stronger predictor of cvs events........LDL or C-reactive protein and why? 21:39:44 [Step_1] a real ? described a teen with history of heroin abuse who presents with dialated pupils, tachycardia, rapid breathing. asked what would worsen symptoms? choices were things like opiods, naloxone, and a couple of others. What do you think? 21:40:04 [crusher] inhibit III of cytocrome oxidase 21:40:15 [sanya] naloxone 21:40:40 [sanya] because he is in withdrawal and it will make it worse 21:40:55 [jwls29] why naloxone? Naloxone is the angagonist 21:41:13 [Step_1] it sounded like he was going through opiod withdrawal, so i think that an opiod antagonist like naloxone would make the withdrawal symptoms worse. 21:41:17 [jwls29] i can't spell today...the antagonist, the antidote 21:41:56 [Step_1] i hope that was right?? 21:42:02 [sanya] yes but the case here is not overdose of heroin it is withdrawal and you do not give naloxone for withdrawal 21:42:15 [jwls29] ok 21:42:29 [sanya] I think I'm pretty sure about this 21:42:41 [quizme2005] jwls herion causes parasymph signs... so giving naloxone causes symph signs (but he already has symph signs from withdrawal) 21:43:31 [jwls29] i wasn't really thinking about the sxs. I was thinking about it more in the terms of he was intoxicated and the antidote is naloxone. you guys are right 21:44:16 [sanya] A pt comes with severe chest pain to the ER you think it is an MI and he just came after attending a party and you see aperforated nasal septum what do you rule out? 21:44:32 [jwls29] cocaine use 21:44:34 [quizme2005] cocaine 21:44:38 [quizme2005] 21:44:43 [zeda] cocaine 21:44:49 [Step_1] cocaine 21:44:59 [sanya] yessssssssss! 21:45:24 [quizme2005] can anyone tell my why dialated cardiomyopathy is there too? 21:46:02 [sanya] could be due to the toxins???? 21:46:11 [quizme2005] im not sure 21:46:13 [zeda] looks like nobody is ready to move on to next topic? 21:46:26 [zeda] ready for vascular patho? 21:46:30 [ayouh] what is the next topic ? 21:46:34 [jwls29] yup 21:46:39 [ayouh] yeah.. 21:46:56 [sanya] silicosis has increased incidence of which infection 21:47:12 [zeda] which one is stronger predictor for cardio-vascu. events......LDL or c-reactive prot. and why? 21:47:14 [sanya] OK lets move 21:47:29 [quizme2005] RA? 21:47:40 [quizme2005] CRP zeda? 21:47:47 [GABA] crp 21:47:58 [jwls29] crp 21:48:03 [quizme2005] sanya is it RA? 21:48:17 [sanya] no its tuberculosis 21:48:31 [sanya] its there in k a p notes 21:48:40 [quizme2005] oh 21:49:01 [jwls29] crp is increased in pts with inflammatory plaques 21:49:02 [quizme2005] i just remember silicosis + RA = caplan 21:49:15 [zeda] Serum C-reactive prot. is increased in pt. with inflamm. plaques which rutures and produce vess. thrombosis....leads to MI.sO,C-reactive prot. is stronger predictor than LDL 21:49:21 [sanya] OK 21:49:31 [jwls29] plaques rupture and produce vessl thrombosis which leads to AM 21:49:36 [jwls29] I 21:49:41 [jwls29] thanks zeda 21:49:48 [zeda] ya 21:50:05 [quizme2005] zeda> thanks man 21:50:46 [zeda] Abrupt onset of severe back pain is followed by hypotension from bld. loss in the retroperitonium......Dx? 21:51:17 [crusher] diss anuerysm 21:51:18 [sanya] rupture of aoritc aneurysm 21:51:23 [quizme2005] AAA 21:51:26 [jwls29] aortic dissection? 21:51:33 [Step_1] agree 21:51:38 [zeda] ya....abd. aortic aneurysm 21:51:57 [sanya] isn't dissection different 21:52:04 [jwls29] yup 21:52:11 [jwls29] it's aneurysm i think 21:52:20 [zeda] most common vasculitis in children? 21:52:25 [quizme2005] dissecting is different 21:52:29 [quizme2005] its knife like pain 21:52:51 [sanya] dissection is retrosternal 21:52:52 [ayouh] kawasaki ? 21:53:01 [quizme2005] (usually marfans, collagen vascular disease 21:53:11 [zeda] Henoch-Schonlein purpura 21:53:17 [jwls29] henoch schonlein 21:53:26 [Step_1] henoch schonlein purpura 21:53:28 [sanya] small vessel vasculitis, Ig A 21:53:39 [GABA] both 21:53:54 [zeda] this is small ves. vasculitis involving skin,GIT,renal,jt. ves 21:54:08 [zeda] C/P? 21:54:10 [sanya] palpable perpura buttocks and lower extremities 21:54:23 [sanya] purpura 21:54:30 [crusher] henoch scholin purpura 21:54:58 [sanya] adominal pain, arthralgia, 21:55:17 [zeda] palpable purpura of buttocks and lower extremities,polyarthritis,GN,GI bleeding 21:55:55 [zeda] what is the role of Sodium in hypertension? 21:56:39 [crusher] it inc HTN cos it cause na/h20 retension 21:56:42 [sanya] increase in plasma volume because it retains water? 21:56:45 [GABA] volume increase 21:57:28 [zeda] ya.....excess Na enters in arterioles sm. ms cells and open Ca channels 21:57:45 [zeda] ng vasoconstriction( inc. diastolic BP) 21:58:25 [sanya] good one 21:58:34 [crusher] if a person hponaterimic what will you give 21:58:40 [zeda] thanks 21:59:09 [quizme2005] dextrose? 21:59:16 [ayouh] glucose and k ? 21:59:22 [ayouh] sorry dextrose 21:59:43 [Step_1] normal saline 21:59:45 [sanya] isotonic saline 21:59:51 [jwls29] agree with step 1 21:59:56 [zeda] saline 22:00:18 [crusher] what do u give a person first in shock cos of h,rrage and why 22:00:20 [ayouh] why saline ? 22:00:38 [quizme2005] crusher whats the answer 22:00:40 [sanya] dextran 22:00:41 [Step_1] never correct hyponatremia rapidly, because you many cause brainstem damage (central pontine myelinosis). 22:00:55 [sanya] because it expands the vascular compartment 22:01:11 [ayouh] oh... 22:01:17 [ayouh] r u sure ? 22:01:29 [crusher] yes always give isotonic saline to replace vol depletion than hyponatrmic sol or .5 nacl 22:01:33 [GABA] cristaloids 22:01:33 [quizme2005] ok now im scared i dont know this 22:01:47 [GABA] them coloids 22:01:55 [jwls29] for person in shock you give ringer's lactate 22:02:35 [crusher] why do we give dextrose in hyponatrimic pat 22:02:51 Pluto enters this room 22:02:51 [sanya] ringer lactate and isotonic or normal salina are all same i gues jwls 22:02:53 [Step_1] my source is crush step 2 pg 10 says give "normal saline is better choice 99 times out of 100 for board purposes" 22:03:05 sunmoon enters this room 22:03:19 [quizme2005] hey step1 do we have to know this? 22:03:21 [ayouh] 99 is good for me..thanks.. 22:03:24 [jwls29] gol jan always says to just give them what they are missing 22:03:42 [jwls29] if pt is hyponatremic you give saline 22:03:53 [crusher] that is right but after giving normal saline 22:03:57 [ayouh] what kind of saline though ? 22:04:00 [jwls29] that stuff is more step 2 though 22:04:01 [Pluto] hi 22:04:20 [zeda] distribution of Temporal arteritis? 22:04:23 [sanya] crusher what about the shock Q 22:04:26 [crusher] why do we give dextrose in hyponatrimic pat 22:04:33 [ayouh] let us stick to step 1 plz...already confused with step 1 stuff... 22:04:33 [zeda] hi pluto 22:04:49 [Step_1] i think you might need to know the central pontine myelinosis risk, but not the actual saline content. just that you shouldn't replace sodium too quickly 22:04:52 [zeda] ok 22:04:57 [crusher] for shock Q,,always isotonic saline or .9 nacl 22:05:02 [jwls29] agree with step 22:05:12 [quizme2005] im too confused now so see ya ppl ill be back much more prepared sorry 22:05:26 [jwls29] don't leave quiz 22:05:29 [quizme2005] bye 22:05:35 [quizme2005] im too confused 22:05:35 [sanya] we don't give dextrose we give N saline or isotonic saloine or Rlactate which is agin .9%saline 22:05:35 [zeda] thans step 1 ....nice info 22:05:59 [zeda] don't go quiz 22:06:04 [Step_1] quiz, dont be discouraged...that was a tough one. we can all learn from each other 22:06:04 [jwls29] it's ok...we should get back to vascular path 22:06:14 [zeda] stay....we have long road to go 22:06:30 [quizme2005] ok.. 22:06:46 [zeda] ok..my Q.... 22:06:49 [ayouh] when is hep b antigen +ve ? 22:06:56 [jwls29] good 22:06:58 [zeda] Distribution of Temporal Arteritis? 22:07:04 [quizme2005] Step_1> thanks ur right 22:07:10 [crusher] dextrose cantain glucose which is co transported with Na ,so its imp to give 22:07:12 [sanya] Poly arteitis nodosa 22:07:24 [ayouh] temporal artery, facial.. 22:07:26 [GABA] after hep b vacc 22:07:48 [ayouh] yeah, and hepatitis b too !!! 22:07:56 [zeda] and ophthalmic 22:08:14 [sanya] Oh i thought you were asking vas path 22:08:14 [quizme2005] temporal arteritis know high ESR 22:08:25 [zeda] aortic arch...giant cell aortitis is uncommon 22:08:44 [jwls29] isn't the antigen positive in early phase of acute infection and chronic hbv? 22:08:48 [sanya] takayasu's 22:08:52 [ayouh] Dx biopsy, tX cortisones 22:08:52 [quizme2005] and predis. to blind 22:08:59 [zeda] ? 22:09:27 [jwls29] ayouh asked a question 22:09:32 [zeda] Taka.....pulseless dis 22:09:35 [jwls29] and i think i got confused 22:09:40 [ayouh] yes, - in immune by vaccicne 22:09:50 [crusher] early id surface antigen and e antigen pos 22:09:56 [jwls29] right 22:10:05 [zeda] loss of pulse in upper extre. 22:10:10 [Step_1] treatment for temp arteritis is corticosteroids....this is very high yield because you can prevent blindness if given within a certain time 22:10:11 [jwls29] they only thing positive in immunization in the anti HBS 22:10:30 [zeda] ya 22:10:36 [jwls29] ok 22:10:48 [crusher] also in gtemp arte ESR is inc imp for Dx 22:10:57 [sanya] ahich vasculitis is steroids contraindicated 22:11:05 [zeda] pathol. feature in Tempo. arteritis? 22:11:08 [jwls29] we always give steroids before biopsy just in case 22:11:35 [Step_1] takyasu....pulseless....mneumonic is "cant taka you pulse" 22:11:54 [ayouh] granulomatous vasculitis ? 22:12:06 [quizme2005] ty step 22:12:06 [zeda] multinucleated giant cells and fragmentation of internal elastic lamina 22:12:36 [sanya] yes takayasu's cortico streoids contraind 22:12:39 [zeda] seg. granulomatous vasculitis 22:13:03 [zeda] and....intimal fibrosis with lumenal narrowing 22:13:19 [Step_1]>[quizme2005] your welcome....mnemonics got me through basic sciences 22:13:39 [quizme2005] 22:13:44 [sanya] in temporal arteritis which is the screening test 22:14:03 [Step_1] ESR 22:14:15 [jwls29] agree with step 22:14:16 [zeda] what is the difference bet Raynaud's dis and Raynaud's phenomenon? 22:14:26 [quizme2005] Step_1> do u think finishing path first helps? 22:14:36 [sanya] yep 22:15:27 [sanya] zeda screening is ESR definitive diagnosis is biopsy 22:15:50 [Step_1]>[quizme2005] path is a very big subject which ties all subjects together. good to do throughout studies because it is so important in my opinion. 22:15:51 [zeda] thanks sanya 22:15:59 [ayouh] phenomenon, secondary to other disease 22:16:07 [jwls29] agree with ayouh 22:16:40 [jwls29] disease is an exaggerated vasomotor response to cold or stress 22:17:02 [quizme2005] Step_1> ty step1 cuz path is my fav subject... im almost done half (havent revised it yet) but im consdering diong it be4 others 22:17:13 [sanya] PAN assctd with HEp B or C 22:17:30 [jwls29] hep b 22:17:42 [jwls29] in 30% of cases 22:17:48 [ayouh] colors are white blue then red 22:18:11 [Step_1] hep b 22:18:14 [zeda] ya 22:18:16 [GABA] hep b 22:18:37 [sanya] yes! 22:18:42 [ayouh] decrease flow, cyanosis then flow is back.. 22:18:42 [quizme2005] zeda> brb im stil here 22:18:57 [Step_1] P-olyarteritis nodosa assoc with P-anca (notice the P relation ) 22:19:01 [jwls29] where else do we see p-anca antibodies? 22:19:37 [jwls29] no lung in pan 22:20:11 [ayouh] astham 22:20:17 [ayouh] eosinophilia ? 22:20:37 [ayouh] chrug something disease whihch is a variant of pan 22:20:41 [jwls29] we see p-anca antibodies in churg strauss sdme 22:20:49 [GABA] lung 22:20:52 [sanya] chrug strauss 22:20:57 [jwls29] yes ayouh 22:21:00 [sanya] churg 22:21:10 [crusher] churg strauss synd with asthma and eosinophilia 22:21:19 [zeda] in 70% cases 22:21:26 [jwls29] yup 22:21:51 [zeda] c/p? 22:22:00 [ayouh] clinical features of pan ? 22:22:33 [zeda] focal vasculitis 22:22:45 [Step_1] fever, pain in involved areas, multisystem disease with infarction 22:22:49 Sugar enters this room 22:22:52 [sanya] Step1 did you read goljan notes notes, because he mentions in bold letters that p-anca is not assctd with PAn but with microscopic polyangitis and I'm not too sure to go with it 22:23:12 [ayouh] have no clue what dx would be...does not involove lung though...Segmental nertotizing vasculitis on biopsy, P-anca +ve 22:23:16 [jwls29] hematuria, renal failure, diarrhea, GI upset 22:23:24 [zeda] organ infarction....in kid( RF),heart( ac. MI),,bowels( bloody diarrhea),skin ( ulcer) 22:23:37 [ayouh] anything could be a symptom 22:23:44 [crusher] very similiar to wegners but involve other organs to 22:23:49 [ayouh] what is P-anca ? 22:24:02 [Step_1]>[sanya] thats where i got it from, goljan gave the mneuomins of P-AN and p-anca....thats strange 22:24:18 [Pluto] \ 22:24:43 [zeda] pernuclear antineutrophil cytoplasmic antibodies 22:24:44 [jwls29] antibodies against myeloperoxidase 22:24:54 [jwls29] it has a correlation with disease activity 22:24:55 [sanya] On page 141 he says P-anca ab's are not present in PAn??? 22:24:58 [ayouh] autoantibody against myeloperoxidase, correlates with disease activity 22:25:06 [Step_1] p-ANCA is antineutrophilic cytoplasmic antibodies with perinuclear staining 22:25:33 [ayouh] can you elaborate step 1 plz 22:25:34 [sanya] in temporal arteritis which is the screening test 22:25:48 [sanya] sorry that q was a mistake 22:25:48 [ayouh] esr 22:25:51 [crusher] ESR 22:25:56 [Sugar] biopsy 22:25:58 [zeda] ESR 22:26:07 [GABA] but P anca is is rarely found in PAN 22:26:19 [sanya] yes esr but I asked it before it was a mistake, sorry 22:26:22 [jwls29] sugar, can you change your color font please? 22:26:26 [ayouh] 75 % 22:26:28 [jwls29] it would be easier to read 22:26:39 [Sugar] ok ?? 22:26:50 [ayouh] 75 % gaba 22:26:51 [jwls29] biopsy is for the definitive diagnosis 22:26:58 [Step_1] i might have a different version of the notes, but on pg 49 of sec 2 of kap lan's path by goljan, and also in his audios, he mentions that it does have p-anca.....not sure which is correct?? 22:27:00 [jwls29] esr is screening test 22:27:01 [crusher] biopsy may not be screeining but mire specific 22:27:04 [jwls29] better 22:27:10 [sanya] MC organ involved in PAN 22:27:58 nne enters this room 22:28:07 [Sugar] all organ except lungs 22:28:12 [crusher] kidneys?? 22:28:13 [jwls29] hi nne 22:28:17 [ayouh] kidney ? 22:29:00 [GABA] kidneys 22:29:15 [Step_1] agree kidneys 22:29:18 [zeda] Cause of Mycotic Aneurysm? 22:29:22 [jwls29] me too 22:29:28 [sanya] yes 22:29:49 [Sugar] bacterial infection 22:29:57 [ayouh] funny, mycotic but bacterial infection 22:29:59 [zeda] right 22:30:03 [jwls29] fungi and bacterial infection 22:30:06 onyx enters this room 22:30:14 [ayouh] thats all i know about it... 22:30:17 [zeda] hi onyx 22:30:26 [onyx] hi everyone 22:30:26 [Step_1] hi onyx 22:30:38 [jwls29] aspergillus,candida, mucor are the fungi 22:30:55 [jwls29] bacteria are bactroides, pseudomonas, salmonella 22:31:01 [jwls29] hi onyx 22:31:06 [zeda] diff. between phleothrombosis and thrombophlebitis? 22:31:10 [ayouh] C-anca ? 22:31:21 [Sugar] wegener 22:31:24 [crusher] wegners 22:31:33 [jwls29] wegener's 22:31:43 [ayouh] correct..what ios c-anca ? 22:32:27 [Sugar] cytoplasmic antineutrophil cytoplasmic autoAb 22:32:32 [zeda] phlebo...ven thrombosis without inflamm. or infection and thrombo........due to inflamm. and bact. infection 22:32:35 [Step_1] look for lung and renal involvement with c-anca....wegeners 22:32:48 [crusher] diff b/w the wegner and good pasture clinically is wegner involve upper resp tract like nasal sinuses,lower resp tract and kidneys while good pasture only loer resp tract and kid 22:33:03 [ayouh] c-anca is autoantibody against proteinase 3 22:33:34 [Step_1] c-anca has diffuse cytoplamic pattern 22:33:37 [jwls29] the way i also remember it is that good pasture is 2 words and so it involves 2 organs: lungs,kidneys 22:34:08 [ayouh] and it is type 2 hypersensitivity 22:34:22 [ayouh] 2 words , 2 organs, type 2 22:34:36 [zeda] ya 22:34:37 [Step_1] good one 22:34:46 [jwls29] cool 22:35:15 [crusher] that is right good pasture is type2 and linear deposition 22:35:29 [zeda] what r the chemicals asso. with liver angiosarcoma? 22:35:46 [Sugar] vinyl chloride 22:35:48 [crusher] thyrocyst,vinyl 22:35:50 [sanya] vinyl chloride 22:36:04 [sanya] thorotrast 22:36:06 [zeda] arsenic 22:36:45 [zeda] too 22:37:04 [sanya] arsenic can cause squamous cell ca of skin 22:37:08 [jwls29] are we going to move onto cardio soon? 22:37:15 [zeda] ya.. 22:37:27 [zeda] lets move in cardiac patho. 22:37:34 [ayouh] yeah 22:37:38 [ayouh] ok.. 22:37:50 [ayouh] mcc of restrictive cardiomyopathy ? 22:38:02 [Sugar] amyloidosis 22:38:03 [sanya] HT 22:38:18 [zeda] most imp. location for distribution of coronary art. thrombosis? 22:38:27 [ayouh] correct amyloidosis and sacrcoidosis 22:38:40 [jwls29] ok 22:38:41 [ayouh] ok... 22:38:45 [Step_1] cardiac myoma 22:38:49 [sanya] sorry i was thinkin' diastolic dysfunc 22:38:50 [crusher] wht is the most common drug causes of death due to prescription drug 22:39:11 [ayouh] humm.. 22:39:33 [Step_1] sorry, i was thinking of something else...i take that back 22:40:15 [ayouh] aspirin ? 22:40:28 [zeda] imp. coronary art. thrombosis distribution....LAD( 45%),rca( 355),LCA( 15%) 22:40:28 [GABA] digital,aspirin?? 22:40:36 [ayouh] not a a prescription drug... 22:40:44 [jwls29] i was thinking that too, but aspirin isn't prescription 22:41:14 [ayouh] hum...can you elaborate crusher plz 22:41:19 [crusher] TcA remember 3Cs coma convulsion carivascular collasp 22:41:22 [ayouh] too many drugs.. 22:42:03 [crusher] ref goljian review page 91 under tca antidepressent 22:42:53 [ayouh] did he say : most common drug causes of death due to prescription drug or just the 3cs 22:43:25 [crusher] it says most common cause of death by PRESCRIPTION DRUG 22:43:41 [ayouh] ok thanks... 22:44:38 [zeda] ECG findings in MI? 22:45:03 [ayouh] st elevation 22:45:06 [Sugar] ST elevation and Tinversion 22:45:10 [ayouh] angina is st depression 22:45:17 [Sugar] Q wave 22:45:17 [crusher] st elevation 22:45:31 [GABA] q wave st elevation 22:45:39 [sanya] ST elevation, evolving Q waves and depression of T wave 22:45:43 [zeda] HOW WILL U CORRELATE THESE WITH MICROSCOPIC CHANGES? 22:46:17 [crusher] microsco[pic changes depend on the time after mi 22:46:18 [Sugar] d/r 24hr to 48 hr - Q wave 22:46:18 [ayouh] but in subendocardial infarct ---====> ST DEPRESSION...does anyone agree...this is in F A 04 22:46:38 [zeda] INVERTED t WAVES....AREA OF ISCHEMIA 22:46:42 [crusher] 3 days neutrophils start appear 22:47:17 [Step_1] subendocardial ischemia will have ST depression according to goljan 22:47:27 [zeda] Elevated ST waves....injured myocardial cells surrounding the area of necrosis 22:47:33 [ayouh] so how would you dx ? 22:47:58 [ayouh] risk factors, symptoms 22:48:15 [GABA] enzimes 22:48:17 [Sugar] a/c to <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>QBank</a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491&type=2&subid=0 >, 22:48:21 [ayouh] ekg then shows st depression, wouldnt we mix up with angina ? 22:48:23 [zeda] by enz. elevation and hist 22:48:30 [sanya] subendocardial Infarction has no Q waves and Transmural has Q waves 22:48:36 [ayouh] oh ok..forgot...thanks.. 22:48:38 [crusher] wait let us describe microscopic finding on specific time periods 22:48:44 [zeda] elevated ST in MI 22:48:53 [Sugar] a/c to <a target=new href=http://click.linksynergy.com/fs-bin/click?id=c97WUMRO5hY&offerid=47491.10000206&type=2 &subid=0>QBank</a><IMG border=0 width=1 height=1 src=http://ad.linksynergy.com/fs-bin/show?id=c97WUMRO5hY&bids=47491&type=2&subid=0 >, enzymes are increased in infarct,but not in ischemia, 22:49:08 [Sugar] hey, mine is now problem 22:49:29 [Sugar] if enzymes r increased ,it is infarct 22:49:32 [Step_1] sugar, you cant type stuff like kap lan, amaxon, etc or you will get a link like above 22:49:44 [ayouh] thanks all..forgot about enzymes...it s ipossible that they would just skip the enzyme part right ? 22:49:55 [Sugar] if enzymes r not increase, it is angina 22:49:59 [zeda] 0-24 hrs....no gross changesuntil 24 hrs after MI 22:50:10 [Sugar] then if infarct, u will DDx with ECG 22:50:42 [crusher] yes after 24 hrs neutrophils start appearing 22:51:05 [Sugar] Neutrophil until 4 days 22:51:15 [zeda] 1-3 days...pallo,myocyte nuclei disappear/ 22:51:17 [crusher] 5-10 days macrophages and granulation tissues 22:51:28 [zeda] 4-7 days......granulation tissue 22:51:28 [Sugar] a/f that , within 1 wk - macrophage 22:51:36 syman77 enters this room 22:51:38 stranger2 enters this room 22:51:43 [ayouh] mcc of death after MI 22:51:53 [Sugar] granulation t/s may be b/t one wk and one month 22:51:55 [crusher] after 7 week scar tissue 22:51:57 [jwls29] arrhythmia 22:51:57 [zeda] 7-10 days.....necrotic area is bright yellow 22:52:01 [Step_1] rupture most often how long after MI? 22:52:01 [sanya] arryhthmias 22:52:06 [Sugar] cardiac arrthymia 22:52:14 [Sugar] during 1-2 day 22:52:20 [crusher] yes lethal arrytmias 22:52:24 [Sugar] rupture- 1 wk 22:52:34 [jwls29] 1 week? 22:52:36 [zeda] 2 mths....infarct tiss. is replaced by white,patchy,non-contractile scar tissue 22:52:36 [crusher] what are the arly and late compliaction of MI 22:52:36 [ayouh] what is dressler syn. ? 22:52:49 [Sugar] yes, ventricular rupture - 1 wk 22:52:50 [syman77] autoimmune 22:52:53 [Step_1] rupture MC on the 3rd to 7th day 22:53:01 [sanya] autoimmune pericarditis 22:53:02 [Sugar] for dressler - 6- 8 wks 22:53:07 [zeda] arrythmias 22:53:12 [zeda] CHF 22:53:21 [zeda] upture 22:53:58 [ayouh] mcc of death of sudden cardiac death ? 22:54:19 [Sugar] CAD 22:54:25 [crusher] dresselar synd is the complication of Mi in which heart ruptures after several weeks 22:54:34 [Step_1] severe atheroschlerosis 22:54:37 [zeda] hypertrophic cardiomyopathy 22:54:38 [Sugar] for young patient, hypertrophic cardiomyopathy 22:54:58 [zeda] what is the cause of sudden death? 22:55:09 [Sugar] which age 22:55:30 [zeda] in hypert. cardiomyopath? 22:55:40 [ayouh] infarction ----> release of antigens into serum -----> body responses by making antibodies which takes 2-3 weeks 22:56:33 [ayouh] general q ---> CAD...but in athlete young who dies suddenly hypertrophic cardiopathy 22:57:04 [Step_1] pt presents with neck vein distention with inspiration (Kussmaul sign), muffled heart sounds, hypotension (assoc with pulsus paradoxus with drop in bp on inspiration). what is this triad called? and what is the diag? 22:57:16 [zeda] bec. of conductance disturbance 22:57:24 [sanya] becks triade 22:57:29 [jwls29] beck's triad 22:57:36 [zeda] Beck's triad 22:57:40 [crusher] cariac tampnade n beckers triad 22:57:49 [jwls29] cardiac tamponade 22:57:49 [Sugar] pericardial teimponade 22:57:49 [ayouh] autosomal dominant more than 50 % of cases : hypertrophic cardiomyopathy 22:58:02 [Step_1] becks triad is correct for the triad....pericardial effusion is the diag 22:58:24 [syman77] if pericarditis...same features with precordial knock...am i riht 22:58:26 [jwls29] ok 22:58:47 [sanya] is it pericardial effusion or cardiac tamponade, step1 22:59:04 [Sugar] tamponade 22:59:14 [GABA] yes 22:59:30 [ayouh] what keeps pda open and what closes it ? 22:59:31 [jwls29] i'm almost positive it's tamponade 22:59:38 [Step_1] the correct answer was pericardial effusion, but i will check to see if becks also in temponade 22:59:41 [ayouh] what is pericardial effusion ? 23:00:02 [crusher] prostgland e open and indomethacin closes 23:00:04 [zeda] diag...pericardial efuusion 23:00:25 [syman77] fluid in pericardial space.. 23:00:30 [sanya] collection of fluid in the pericardial sac which usually has about 25ml. 23:00:40 [Step_1] pericardial effusion is basically result of blood refluxing behind the heart 23:00:47 [Sugar] patent ductus arteriosus 23:01:07 [ayouh] ok thanks 23:01:30 [jwls29] i'm going to have to respectfully disagree with you on this, step 1 23:01:35 [zeda] want to move in RS? 23:01:40 [ayouh] mc type of cardiac myopathies ? 23:01:48 [quizme2005] ayouh pge2 keeps pda open, indo closes it 23:02:01 [crusher] constricitive 23:02:09 [ayouh] yes..go ahead...yeah quize ther you go stay here 23:02:24 [Step_1] yes, both correct......"A triad characteristic of acute cardiac tamponade, consisting of high venous pressure, a low arterial pressure, and decreased heart sound." great job everyone! 23:02:28 [Sugar] coxackie 23:02:34 [quizme2005] im here i was in wshrm 23:02:39 [Step_1] so becks seen in both 23:02:40 [syman77] kwl way to remember it is PGA open for golf... 23:02:42 [zeda] Newborn's mother complains that her baby turns blue during breast feeding and pinken-up when cries...Dx? 23:02:44 [ayouh] dialated cardiomyopathy 23:02:59 [Sugar] TOF 23:03:15 [quizme2005] i agree with suga 23:03:40 [Step_1] mneumonic is the "PGA Open" (golf) to remember that PG opens the PDA 23:03:49 [crusher] tracho oesophafgeal fistula 23:03:55 [Step_1] oops....i type too slow 23:04:00 [quizme2005] nice step 1 23:04:04 [ayouh] nice step 1` 23:04:07 [quizme2005] nice syman 23:04:23 [syman77] thanks.. 23:04:28 [Step_1] syman beat me to it....good job syman 23:04:49 [syman77] hehe 23:05:40 [crusher] pneumonic og constric cario is ABCD=alcohol,beriberi,coxecia B,doxirubacin,diastoilic dysfunction(ref fir t Ai d) 23:06:37 [sanya] Step1 how was the cardio stuff in the exam is it doablw tih goljan 23:07:00 [sanya] I mean doable with goljan 23:07:24 [crusher] what is the effect of lying down on the cardiac out put in IHSS? 23:07:28 [Step_1] i swear by goljan....i wasnt so sure about him before exam, but now i know that he really prepares you will for exam 23:08:00 [jwls29] where did zeda go? 23:08:22 [Sugar] IHSS ??? 23:08:22 [sanya] Thanks I heard they aska lot about murmurs etc 23:08:24 [quizme2005] u there zeda? 23:08:41 [Step_1] good question....where is zeda? 23:09:26 [crusher] whateffect of valsal maneuvor on IHSS? 23:09:36 [sanya] may be she just dozed off.......... 23:10:07 [sanya] increases the intensity of murmur in IHSS 23:10:08 [Sugar] crusher - what is IHSS ??? 23:10:38 [crusher] hypertrophic cardiomyopathy 23:10:53 [sanya] idiopathic hypertrophic subaortic stenosis 23:11:29 [ayouh] most frequent valvular leesion ? 23:11:29 [crusher] sanya can you expalin why? 23:12:32 zeda enters this room 23:12:48 [jwls29] zeda, we were wondering where you went 23:12:57 [quizme2005] 23:13:03 [ayouh] lets talk murmurs plz...very weak in them.. 23:13:12 [ayouh] i am i mean.. 23:13:13 [sanya] because when the blood flow to the heart decreaes wi h Valsalve maneuvre the L ventricale is smaller and the obstruction increases 23:13:28 [zeda] sorry guys ..i was disconnected 23:13:35 [Step_1] welcome back zeda! 23:13:37 [sanya] sorry for the spelling mistakes guys 23:13:39 [jwls29] ok 23:14:01 [quizme2005] speaking of heart does anyone know what is the afferent and effrent of heart reflex (slowing down) 23:14:10 [ayouh] can we start with the common high yeild ones plz ? 23:14:19 [quizme2005] i came across a question bout that 2day 23:14:26 [sanya] parasympathetic slows 23:14:26 [Step_1] machinery murmur heard in what? 23:14:31 [sanya] PDA 23:14:35 [crusher] ok thanks sanya 23:14:42 [ayouh] vagus slos.. 23:14:44 [quizme2005] sanya i know but what nerve? 23:14:48 [ayouh] slows 23:14:56 [quizme2005] vagus is efferent or affrent? 23:15:09 [quizme2005] step 1 can u help me out? 23:15:14 [ayouh] afferent i think 23:15:38 [Step_1] machinery murmur = PDA ...mneumonic is a "PDA (palm pilot) is a machine" 23:15:57 [zeda] so we r still in cardiac? 23:16:22 [ayouh] great step 1 23:16:22 [zeda] ok 23:16:31 [quizme2005] yup 23:16:37 [sanya] we didn't do murmurs and it is very important 23:17:01 [crusher] let start murmurs 23:17:35 [crusher] holosystolic blowing murumur which condition you will see 23:17:49 [sanya] VSD, MR, TR 23:17:55 [ayouh] is whatever in f a for murmurs enough ? 23:17:55 [quizme2005] Step_1> vagus is efferent or affrent? 23:18:16 [Step_1]>[quizme2005] the hethe predominant tone in the heart is parasympathetic which slows the heart down. if you block the effect, you will have unopposed sympathetic stim so you will have tachy 23:18:41 [crusher] right sanya 23:18:42 [Step_1] is that what you meant? 23:18:49 [zeda] hi usmle 23:19:05 [quizme2005] Step_1> yeah, but i was doing a quiz question 2day and it asked my what is the efferent and afferent parasymph of the heart? 23:19:10 [usmle_exam] Hi 23:19:35 [quizme2005] Step_1> choices were vagus, glosspharyngeal, upper or lower ansa cervicalis 23:19:54 [ayouh] vagus defenitely 23:19:55 [crusher] how can you differntiate holosytolic murmur of MR and VSD 23:20:03 [quizme2005] Step_1> were 2 questions (one for affrenct and one for effrent) same choices for both 23:20:09 sohel enters this room 23:20:31 [ayouh] mr high pitched ? 23:21:01 [sanya] MR it is at the apex radiating to axilla 23:21:19 [sanya] VSD along the L steranl border 23:21:24 [Step_1] do you have the exact question? or can you be more specific. not sure what they're asking? 23:21:26 [sanya] sternal 23:22:36 [sanya] has diamond shaped configuration, systolic or diastolic 23:22:51 [crusher] MR first its high pitch blowing murmur and second its location at apex of heart 23:22:55 [quizme2005] Step_1> the question was "what is the affrent nerve supply for the heart reflex (slows the heart down)?" naturally i thought something to do with carotid bodies etc 23:23:13 [Step_1] i always remember it as APT M (apartment M). it goes AP on 2nd ICS and TM on 5th intercostal. there is a good diagram and question in the step 1 forum that i will bump...once you see it, it'll stick in your head 23:23:19 [sanya] which murmur has diamond shaped configuration, systolic or diastolic 23:24:30 [Step_1]>[quizme2005] maybe they mean the carotid body vs the carotid sinus. one is with pressure and the other with o2 sat?? 23:24:55 [ayouh] what r u talking about step 1 ? 23:24:57 [quizme2005] nvm step 1 thanks for trying 23:25:01 [sanya] quizzme if it is the carotid bodies then the afferents are more likely th GN 9th N 23:25:29 [ayouh] murmurs...i really appreciate if you stick sometnin to my stick-less head 23:25:36 [quizme2005] makes sense sanya and the effrent is prolly vagus 23:26:25 [crusher] cresando decresando ,,,,aortic stenosis?? 23:26:41 [sanya] no the aortic bodies have the 10th N as afferents 23:26:58 [sanya] yes crusher 23:27:00 zeda enters this room 23:27:24 [quizme2005] welcome back zeda 23:27:47 [zeda] sorry .....disconnected again 23:27:47 [crusher] wb zeda 23:27:56 [zeda] thanks quiz 23:28:11 [zeda] thanks crush 23:28:20 [sanya] pul murmur L 2nd ICS, aortic R 2nd ICS, Mitral apex, Tricuspid along L steranl border 23:29:14 [sanya] which is the murmur between S1 and S2 23:29:39 [Step_1]>[quizme2005] the sinus will detect high pressure, which will result in increased parasymp activity to heart (slow down) via vagus....right? 23:30:00 [quizme2005] yes step 1 23:30:08 [crusher] APT...M is pneomonic for location of valves 23:31:02 [Step_1] http://www.valuemd.com/viewtopic.php...&highlight=apt for heart sounds 23:31:05 [quizme2005] sanya i dont think there gonna ask mumurs and if they do maybe 1 or 2 questions (i think its mostly step 2 ) 23:32:02 [zeda] we should move to RS now? 23:32:21 [crusher] mitral stenosis sayna? 23:32:24 [quizme2005] sure zed 23:33:01 [sanya] quizzme, this was told by many who did the step1 exam that murmurs heart sounds and the drawings like configurations are the most commonly asked stuff. 23:33:10 [zeda] post-op pt. presents with restrictive breathing and fever........MC cause? 23:33:19 [Step_1] actually, murmurs are hit often as part of stem for clues on diagnosis. it can help narrow it down a bit if you know them well...at least the big ones 23:33:44 [quizme2005] thanks sanya and step 1 23:33:51 [crusher] ms/mr/as and As r big ones 23:34:20 [jwls29] atalectasis 23:34:36 [zeda] resorption atelectasis...d/t mucous plug blocking the terminal bronchioles 23:34:41 [crusher] agree with jwls 23:34:51 [zeda] right jwls 23:35:26 [zeda] MC aspiration site in Lung? 23:36:13 [zeda] sup. segment of the rt. lower lobe 23:36:13 [jwls29] depends on position of the patient 23:36:17 [Step_1] the impt buzzwords are things like high pitched blowing = AV/PV regurg, machinery murmur = PDA, cresendo/decresendo and ejection click = aortic stenosis, opening S-nap = MV/TV S-tenosis, fixed splitting of S2 = ASD, etc. 23:36:22 [zeda] ya... 23:36:23 [sanya] R lower lobe usually 23:36:47 [zeda] right too....but still MC is sup.seg. 23:37:30 [zeda] perfusion is greater than ventilation 23:37:47 [sanya] lower lobe because of increased perfusion 23:38:06 [zeda] ya... 23:38:25 [sanya] thanks zeda 23:38:37 [quizme2005] zeda> post-op pt. presents with restrictive breathing and fever........MC cause( how does that tell u resroption atelectasis?_ 23:39:18 [zeda] why Cigarette smoking is MC cause for emphysema?e 23:39:34 [quizme2005] neutrophilia ( release elastase) 23:40:40 [jwls29] imbalance between elastase in neutrophils and antielastases 23:41:20 [crusher] imbalance b/w elastase and antielastse ,,neutrophils inc more elase 23:41:33 [zeda] if it is within 24-36hrs after surg......MC cause is reso. atelectasis 23:41:36 [ayouh] most common type of emphesyma ? 23:42:09 [quizme2005] zeda> thanks 23:42:20 [crusher] panacinar? 23:42:24 [zeda] centriacinar 23:42:41 [quizme2005] panaci 23:42:48 [sanya] centrilobular assctd with smoking MC 23:42:56 [ayouh] THE CENTER IS THE DOMINANT !!! 23:43:10 [quizme2005] doh 23:43:17 [zeda] panaci. is asso. with hereditary alpha1-antitrypsin defi, 23:43:45 [ayouh] (C)igarete (C)entriacina 23:43:50 [crusher] ok thanks for explan 23:43:55 [zeda] Pink Puffer......?Blue Bloaters......? 23:44:12 [quizme2005] CB 23:44:21 [sanya] PP emphysema BB bronchitis 23:44:51 [Step_1] pink puffer is emphysema and Blue Bloater is Bronchitis (notic the B's) 23:45:23 [zeda] MC extrathorasic site of Bronchogenic ca? 23:45:46 [sanya] liver 23:46:10 [zeda] Adrenals ( >50%),liv,brain,bone 23:46:14 [sanya] sorry i meant metastasis 23:46:37 [jwls29] agree with zeda 23:46:59 [Step_1] agree too 23:47:03 [ayouh] agree zeda thats why they order ct of abdomne 23:47:12 [zeda] ya..... 23:47:20 [zeda] at else imp. in RS? 23:47:44 [ayouh] paraneoplastic syn. ? 23:47:46 [quizme2005] paraneoplastic 23:47:49 [quizme2005] 23:49:04 [ayouh] genes associated with bronchogenic CA 23:49:18 [zeda] now Renal...?distant effect of tum.,unrelated to metastasis 23:49:22 [sanya] which lung ca do you get hypercalcemia 23:49:26 [Step_1] mcc of pneumonia in cystic fibrosis? 23:49:38 [crusher] l.myc 23:49:40 [sanya] pseudomonas 23:49:50 [ayouh] oncogenes : l-myc--->scc k-ras ---> adeno ca 23:49:52 [crusher] p.aurogenosa 23:50:04 [jwls29] ok folks, i'm done for tonight 23:50:06 [Step_1] pseudomonas is correct...good job 23:50:10 [jwls29] have a good night 23:50:14 [ayouh] tumor suppressor genes : p53 , rb 23:50:21 [ayouh] bye jwl 23:50:21 [jwls29] i'll see some of you tomorrow for discussion on ** 23:50:23 [quizme2005] bye jwls 23:50:30 [jwls29] if not, i'll see you next tuesday 23:50:31 [ayouh] yeah..see u tomorrow 23:50:35 [Step_1] good night jwls...thanks for chat 23:50:44 [zeda] thanks jwls 23:51:02 [jwls29] nite 23:51:11 [sanya] guys i think i'm calling it a day too, I'm tired 23:51:14 [zeda] goodnight 23:51:14 [ayouh] chromsome defect in cystic fibrosis ? 23:51:21 [ayouh] nite sanya 23:51:24 [quizme2005] ima turn in too ppl haveta go to video lectures tomorow thanks zeda step1 sanya ayouh bye and gnit 23:51:50 [zeda] thanks quiz... 23:51:54 [ayouh] CFTR on chromoseme 7 ? 23:51:57 [sanya] goodnite to all of you! 23:51:58 [ayouh] bye quiz 23:52:09 [Step_1] good night quiz. great chatting with you 23:52:12 [zeda] see u in next chat 23:52:15 [quizme2005] zeda> check ur pm.. 23:52:16 [quizme2005] bye 23:52:21 [quizme2005] will come 23:52:24 [zeda] ok 23:52:57 [crusher] good night everyone 23:53:09 [crusher] thanks for great qs 23:53:13 [ayouh] nite crusher 23:53:25 [ayouh] who is staying ? 23:53:26 [zeda] good night crush....thanks for chat 23:53:31 [Step_1] good night to all.....thanks zeda for setting up this great chat 23:53:49 [ayouh] when is next meeting ? 23:53:57 [zeda] thanks step1..it was not possible without u 23:54:10 [ayouh] thamks step 1 23:54:11 [zeda] u r the backbone 23:54:31 [crusher] sanya if you there can u answer for diamond shape murmurs systoli/diastolic 23:54:41 [ayouh] what about tomorrow ** ? 23:54:49 [Step_1] i tried to stay quiet for most part and only help out occassionally. you definitely deserve the credit for this great chat zeda 23:55:10 [zeda] thanks step 1 23:55:15 [zeda] u r so nice\ 23:55:36 [ayouh] anyone staying ? 23:55:51 [Step_1] ** is tomorrow and sat, path is on tues...is that correct? 23:56:43 [ayouh] hello...anyone staying...? 23:57:06 [zeda]>[Step_1] ...r u going to post the transcript of this chat? 23:57:12 [zeda] will be thankful 23:57:13 [ayouh] crusher r u staying ? 23:57:41 [Step_1] i was about to ask if you the same....i'd be happy to post it if you prefer? 23:58:04 [zeda] yes....i prefer u 23:58:06 [ayouh] u staying step 1 ? 23:58:23 [zeda] i was disconnected two times..... 23:58:42 [zeda] maybe i don't have full transcript 23:58:46 [crusher] i m here for a while ayoun 23:58:52 [Step_1] ok, i will post it. i was going to go, but will stay a little longer if you need someone to chat with 23:58:59 [ayouh] wanna continue ? 23:59:18 [zeda]>[Step_1] thank u so much......i will leave now 23:59:23 [zeda] as too late 23:59:24 [crusher] ok 23:59:39 [ayouh] i am just not that sleepy and was thinking if someone was still here we can continue thats all...but plz feel free... 23:59:58 [zeda] good night everybody......so nice all of u and thanks to all of u --------- The messages that have been sent today start below --------- 00:00:03 [ayouh] throw a couple at me ? 00:00:13 [ayouh] good night zeda 00:00:26 [zeda] goodnight ayouh 00:00:33 [Step_1] good night zeda....and thanks again...you're doing a wonderful job 00:00:36 [zeda] pl. join next chat too 00:00:37 [ayouh] treatment of scc ? 00:00:50 [zeda]>[Step_1] .thans step1 00:00:51 [ayouh] thnanks i will.. 00:00:54 [zeda] goodnight 00:01:32 [ayouh] em findings in SCC ? 00:01:33 [crusher] small cell ca?? 00:01:47 [ayouh] yup..     |
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07-14-2004, 01:33 AM
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Thank u so much
Hi Step1,
Thank u so much for posting the Transcript.Luckily it was saved on my comp. somehow  and few ppl wanted to discuss more....( when i entered again!! )..so Renal is also covered for next half an hr.So,I just posted full transcript.Your support is invaluable  Thanks again zeda |
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