chat transcript - behavioral science (sleep, dsm, cortical f

[Anonymous]

20:59:36 >[Step_1] Welcome to our chat. Please obey the net etiquette while chatting: try to be pleasant and polite.

20:59:44 [snigtha] is the syep1 chat ere

21:00:01 [snigtha] hi

21:01:06 butter enters this room

21:01:33 [snigtha] butter> hi

21:01:35 [Step_1] hi snigtha and butter

21:02:02 [butter] hi, is there step 1 discussion here?

21:02:07 [snigtha] how r u all

21:02:13 hutals enters this room

21:02:43 [Step_1] yes, tonight is behavioral science

21:02:48 ayouh enters this room

21:03:02 [ayouh] Hello to All...

21:03:30 tau enters this room

21:03:33 [butter] i see

21:03:33 [Step_1] hi alouh

21:03:40 [snigtha] ia new to this discussion,hope i can contribute something

21:03:47 [tau] hi iam the step 1

21:04:02 [tau] hello

21:04:23 [Step_1] its great to see some new and old faces....ready to get started

21:04:26 [tau] Im new

21:04:35 [Step_1] hi tau

21:04:37 [tau] yeah man

21:04:47 [hutals] hi all

21:04:48 [tau] iam from venezuela

21:05:29 [Step_1] welcome, we have people from all around the world

21:05:35 [ayouh] tau> plz pick a brighter color...we want to see what you say...!!

21:05:47 narang_nandini enters this room

21:06:05 [snigtha] im from uk, itz 2.00 midnight,plz keep me awake

21:06:07 [tau] all tonight you meeting to discuss something

21:06:10 [Step_1] hi narang

21:06:27 [Step_1] yes, tonight is behavioral science

21:06:32 [tau] do you like this

21:06:37 [snigtha] hi navarang

21:06:38 [tau] no

21:06:54 [tau] an this

21:06:58 [ayouh] a little brighter would appreciated plz..

21:07:00 [narang_nandini] hey u can call me nandini..

21:07:06 [tau] yeah man

21:07:11 [ayouh] the pink one is better tahnks

21:07:15 [tau] oki

21:07:20 [ayouh] thanks

21:07:28 [Step_1] ok, hi nandini

21:07:30 [ayouh] great..thanks a lot..

21:07:38 [tau] you welcome

21:08:07 [Step_1] ok, lets start with sleep.....what stage of sleep is associated with sonabulism (sleep walking)?

21:08:15 [snigtha] hello nandini

21:08:20 [tau] 2

21:08:27 [narang_nandini] stage 4

21:08:31 [snigtha] stage4

21:08:32 [tau] no REM

21:08:49 [narang_nandini] hello snigtha..ur name seems familiar

21:08:55 [Step_1] sonabulism is seen in stage 4 sleep (aka delta). very good.

21:09:12 [tau] aaaaaaa tabien

21:09:15 [snigtha] hi, same to me

21:09:51 [Step_1] what is difference between hypnagogic and hypnapompic?

21:09:54 [tau] What is the stage that the most people dont have?

21:10:04 [tau] sleep

21:10:42 [narang_nandini] hypnogogic....are hallucination experienced while GOing to sleep

21:10:58 [snigtha] first while faling sleep, next waking up hallucinations

21:11:17 [narang_nandini] and hypnomopic ..are ex. while awaking

21:11:22 [snigtha] stage 4#

21:11:30 [Step_1] both are hallucinations, but GOgic is with GOing to sleep and pompic is on wakening ("pump out of bed")

21:11:40 [Step_1] good job

21:11:47 [narang_nandini] u can remember go in hypnoGOgic

21:12:10 [Step_1] good one nandini

21:12:26 [narang_nandini] thanks

21:12:43 [Step_1] tau, is the answer stage 4 because in the second half of sleep and most don't get full night of sleep?

21:13:22 [narang_nandini] in what stage we normally spend maximum time

21:13:25 [Step_1] also, elderly don't have stage 4 sleep??

21:13:53 [tau] no the answer is stage 2

21:13:59 [ayouh] stage 2

21:14:12 [Step_1] is it stage 2 nandini?

21:14:39 [ayouh] 45 % according to F A 04

21:15:09 [snigtha] surprising,thatz stage we spend max time in,isn't it?

21:15:35 [tau] oki that right

21:16:02 [Step_1] are you saying that stage 2 is both the one we spend most time in and also the one which most people dont have??

21:16:21 [tau] yes

21:16:38 [ayouh] in stage 2 we get Deep Sleep and we get 2 things that are only in stage 2 : Sleep Spindles "deeper sleep and most time" K Komplexes..

21:16:43 [Step_1] interesting

21:17:12 [tau] yes i agree with you

21:17:30 [Step_1] which stage has nitemares? which has night terrors?

21:18:12 [ayouh] terrors is 3-4...and I think nightmare are REm ?

21:18:17 [snigtha] nigtmares rem, terrors satge 4

21:18:42 [tau] NREM 4

21:18:59 [Step_1] nightmares occur during REM sleep and terrors in stage 4 sleep. the distinction is that you remember the mares but do not remember terrors

21:19:17 [narang_nandini] hey ...sorry ...i got sth urgent and have to leave...see u guys later

21:19:43 [snigtha] bye nandini

21:19:48 [tau] yeah REM

21:19:55 [tau] bye nandini

21:20:11 [butter] if one wake up from REM, he will remember the dream right?

21:20:12 [Step_1] ok nandini...hope nothing serious. talk to you later

21:20:46 [tau] yes

21:20:51 [tau] remember that

21:20:58 [Step_1]>[butter] yes, thats right

21:21:30 [Step_1] which neurotrans is assoc with initiating sleep?

21:21:50 [tau] serotonine

21:22:04 [snigtha] dopamine, serotonin,

21:22:36 [Step_1] serotonin assoc with initiating sleep....dopamine produces arousal and wakefulness

21:23:14 [tau] yes

21:23:15 [snigtha] ok,thanks step_1

21:23:22 [Step_1] which neurotrans is high and which is low during REM...Ach vs NE?

21:23:53 [snigtha] ach high, ne low

21:23:59 [tau] If a patient tell you doc I sleep lke a baby What do you think?

21:24:47 [tau] the ach is associated with erections

21:25:17 [Step_1] babies sleep alot

21:25:39 [tau] aja and?

21:25:54 [Step_1] Ach is higher in REM and NE is low. The question that came up was a pt will Alzseheimers has what effect on sleep? They will have decreased REM

21:26:34 [snigtha] what does taht mean, sleep hours and periods increased -depression or stage 4 sleep for long time

21:26:43 [tau] the ach is low in alzheimer

21:26:46 [Step_1] yes, REM is associated with errections which explains about morning erections since REM is usually just before waking

21:27:06 [snigtha] agre with tau

21:27:13 [butter] AD has high ach, ach higher in REM, why AD pt less REM?

21:28:57 [tau] the enuresis what stage is it and treatment?

21:29:55 [Step_1]>[butter] not sure about that one? do you have an answer?

21:30:07 [Step_1] stage 4, imipramine

21:30:18 [tau] yes

21:30:32 [butter] no, i don't know about transmitter, just saw the conclusion found it in conflict with AD

21:30:40 [butter] anyway....

21:30:42 [tau] sawthooth waves where?

21:31:07 [Step_1] interesting butter, i'll need to look that up later

21:31:23 [tau] no the AD has low ach and affect the sleep

21:31:26 [butter] ok

21:31:49 [Step_1] imipramine works for enuresis by decreasing stage 4 sleep

21:31:53 [tau] remember alzaimer of A of ACH

21:31:55 [snigtha] how much sleep can b regained after sleep deprivation

21:31:59 [tau] decrease

21:32:07 [butter] never

21:32:29 [Step_1] i think one third

21:33:18 [butter] i remember never regain all sleep,not sure how much can be regained though

21:34:20 [Step_1]>[snigtha] do you have an answer?

21:34:40 [snigtha] 1/3 is right, Up to 80% stage4 &50% REM

21:34:58 [butter] yeh right, just looked...

21:35:14 [Step_1] i thought it was something like that....although it never feels like it

21:35:58 [Step_1] ok, ready for some DSM stuff?

21:36:13 [tau] yes

21:36:28 [snigtha] yes

21:36:35 [tau] plomo

21:36:39 [Step_1] which axis is personality disorders? what else in that axis?

21:36:54 [snigtha] axis 2

21:37:12 [tau] 2

21:37:14 ayouh enters this room

21:37:26 [snigtha] PDs and mental retardation

21:37:38 [tau] 3

21:37:46 [Step_1] personality disorders and mental retardation are part of axis 2....good job.

21:38:17 [Step_1] physical conditions in axis 3

21:38:29 [Step_1] what is in axis 1?

21:39:05 [tau] schizophrenic,affective,anxiety and somatoform

21:39:19 [tau] and other

21:39:51 [Step_1] clinical disorders like schizo, affective, anziety and somatoform. also anorexia, buimia, secual disorders, slepp disorders, autism....good

21:39:55 [snigtha] almost all the psychiatric conditions except PDs and MR

21:39:58 [tau] anorexia,bulimia sexual disorder

21:41:06 [Step_1] dysthymic disorder, victim of child neglect, reading disorder, influenza, ....put them in the right axises

21:41:49 [snigtha] DYSTHYMIA--AXIS 1

21:42:21 [tau] all in 1

21:42:33 [snigtha] VICTIMof child neglect axis 4

21:43:01 [Step_1] so far so good snigtha

21:43:02 [snigtha] influenza-axis3

21:43:10 [tau] oh sorry that rigth

21:43:53 [Step_1] the reading one is kinda tricky...also in axis 1.....great work!

21:45:08 [Step_1] ok, so lets talk a little about the different things from each axis starting with axis one. what is the major difference between anorexia and bulemia?

21:46:52 [hutals] weight?

21:46:52 [butter] anorexia >15% ideal body weight loss poor sexual adjustment

21:47:11 [snigtha] anorexia-abnormal perception of body image,10-15% below the normal wt

21:47:15 [hutals] sorry.......better color.......weight?

21:47:28 [tau] anorexia the patient dont recognize the problem

21:47:46 [tau] an they dont fat

21:47:49 dia_huq enters this room

21:47:59 [snigtha] amenorhea

21:48:09 [Step_1] there are a few differences although they often overlap. But a main one is that anorexics have significant weight loss >15% of expected body weight, whereas bulemics tend to be normal body weight or close to it.

21:48:17 [Step_1] hi dia

21:48:45 [snigtha] hello dia

21:49:49 [Step_1] the amenorrhea is a good point in anorexics because they are underweight and will not have menses (lack of nutrition)

21:49:58 [tau] the anorexica is the worse because the patien will be die

21:50:17 [tau] by desnutrition

21:50:31 [Step_1]>[tau] thats also a good point.....what will they usually die of?

21:50:54 [snigtha] yes

21:51:30 [tau] remember the anorexia always feel fat

21:52:12 [Step_1] the MCC of death is cardiac arrythmias due to electolyte imbalance

21:53:37 [butter] for anorexia

21:53:44 [snigtha] cardiac arrythmias r more common with bulimia, becoz of induced vominting ang purging,correct if iam wrong

21:54:03 [butter] key classic signs are appearance of lanugo and amenorrhea

21:55:38 [butter] yeh it's said cardiac abnormalities with bulimia

21:56:07 [butter] anorexia has dental cavity due to they don't brush teeth because they think toothpaste is close to food

21:56:16 [Step_1] bulemics will have electolyte disturbance of hypokalemic metabolic alkalosis, but not the ventricular arrythmias seen in anorexia i dont think

21:56:28 [butter] bulimia has dental cavity due to acid from vomitting on teeth

21:56:59 [butter] well anorexia also has nutrition issue therefore dental cavity

21:57:40 [snigtha] good information,thanks butter

21:57:51 [Step_1] anorexics also have osteoporosis from estrogen lack

21:58:44 [Step_1] what is the difference between schizophrenia and schizophreniform?

21:59:41 [tau] the schizophrenis have alluciation

22:00:05 [tau] hallucinations

22:00:14 [snigtha] first is longer duration,second is les than 6 months

22:00:19 [tau] the other not has

22:00:45 [Step_1] time is the only difference. schizophreniform is the symptoms of schizophrenia, but for less than 6 months. once passed 6 months, called schizophrenia.

22:01:06 [tau] the major hallucination is auditory

22:01:29 [tau] bizarre delusion

22:01:41 merjo13 enters this room

22:01:52 [tau] the schizophrenic clasificate in paranoid

22:01:53 [Step_1] hi merjo

22:02:02 [tau] disorganized

22:02:09 [merjo13] Hi Step 1

22:02:14 [tau] undifferentiated

22:02:16 [merjo13] Hi everybody

22:02:20 [tau] residual

22:02:34 [tau] the other in paranoid

22:02:38 [hutals] hey merjo

22:02:40 [snigtha] visual hallucinations r comon with?

22:02:51 [snigtha] hi merjo

22:02:57 [merjo13] Hi hutals

22:03:14 [tau] schizoid and schizotypal

22:03:26 [tau] visual is with alcohol

22:03:32 [tau] delirium tremens

22:04:18 [Step_1] schizoid i think

22:05:07 [tau] no the schizoid dont have hallucination

22:05:59 [Step_1] maybe i'm thinking of schizotypical that has "magical thinking"

22:06:04 [tau] remember the mejor different between is the schizophrenic have hallucination

22:06:05 [snigtha] delirium tremens is correct

22:06:30 [tau] but magical thinking

22:06:41 [tau] no hallucianations

22:07:13 [Step_1] magical thinking with ESP, telpathy, ideas of reference, illusions, etc

22:08:39 [snigtha] not sure about this part

22:09:02 [tau] ok but illusioon is misperception of real stimuli

22:09:10 [tau] and hallucination is

22:09:18 [Step_1] a questions described a patient who was admitted a couple of days ago for elective surgery. now is restless in hospital room with hallucinations. what is dx?

22:09:23 [tau] sensory impression no stimuli

22:09:43 [snigtha] delirium tremens

22:10:09 [tau] give options

22:10:11 [Step_1] magical thinking with ESP, telpathy, ideas of reference, illusions, etc --> this is seen in schizotypical

22:10:43 [tau] realy?

22:10:53 [Step_1] post op infection, alcohol withdrawal, reaction to anesthisia are the choices

22:11:22 [snigtha]>[Step_1] that is right, but do we come across hallucinations

22:11:36 [tau] reaction to anesthesia

22:12:08 ayouh enters this room

22:12:32 [Step_1] sorry, probably confusing because i'm speaking of 2 things at once......the magical thinking was referring to the schizotypical discussion and the choices were in reference to the question about the hosptial pt with hallucinations

22:12:54 [Step_1] 2 separate topics

22:14:35 [Step_1] the correct answer, at least in my opinion, is that the patient was having delirium tremens as snigtha suggested. the problem is that the pt is an alcoholic who doesnt have access to alcohol because stuck in bed in hospital. the hallucinations is the give away

22:14:40 [snigtha] whatz the answer for pre op question?

22:16:06 [Step_1] do you agree with that answer because the real answer is not provided?

22:17:03 [snigtha] which pathway is most involved in schyzophrenia?

22:17:17 [snigtha]>[Step_1] i agree with u

22:17:53 [Step_1] dopaminergic

22:18:29 [snigtha] at what level

22:19:49 [Step_1] meso limbic corico pathway?

22:20:00 [snigtha] the answer is meso-cortico-limbic pathway.

22:20:33 [snigtha] right step1

22:20:51 [Step_1] good question

22:21:21 [snigtha] thanks

22:22:22 [snigtha] r u there ayouh,butter,tau?

22:22:25 [Step_1] which personality disorder often displays spitting?

22:22:49 [hutals] borderline

22:23:29 [snigtha] narcisstic? not sure

22:23:59 [Step_1] thats right, borderline often display splitting (all good or all bad) and passive agressive.

22:25:10 [Step_1] what is the difference between obsessive and compulsive or give an example?

22:26:22 [snigtha] obsession is the thought and compulsion is the act to releive the anxiety assosiated with thought

22:26:37 [hutals] obsession focuses on one thought, usually to avoid another. compulsion is a repettive action which shields person from thoughts

22:27:02 [butter] they can't stand change over all

22:27:32 [Step_1] exactly, very good. obsession example is feeling dirty, compulsion might be to wash hands 100 times

22:27:35 [butter] how to differentiate it from obssesive-complulsive anxiety disorder?

22:27:47 [snigtha] what is treatment for this

22:28:07 [Step_1] ssri's

22:28:54 [snigtha] OCD is limited to one perticular thing, anxiety shows up in more than one function

22:29:23 [butter] yeh anxiety disorder is focal and acquired, while personality disorder is pervasive and life long

22:29:42 [Step_1] in disorder, they recognize that there is something strange in behavior, but in personality, by definition, its egosyntonic meaning that the person is not aware of any problem

22:31:32 [Step_1] i agree with what both of you said also....a few things distinguish the two

22:33:00 [snigtha] friends ,need advice

22:33:28 [Step_1] ok, go ahead. will try to help

22:33:46 [snigtha] do we need to learn all therules with no.s in doc-patient relationship and ethics

22:34:37 [butter] i can't recall all of them, but every rule makes sense to me

22:34:39 [Step_1] doc patient relationship has been very heavily tested. it gets most people because they neglect this area

22:35:03 [snigtha] or is it enough if we can grab trhe essence

22:35:43 [Step_1] if you look at the end of the last chat transcript, you will see some examples of questions on this

22:36:32 [snigtha] they test the content only or ever ask by no.s .isn't it?

22:36:45 [snigtha] but never

22:36:50 [Step_1] you need to grab the essence i think because they will not likely ask for the rule, but will give you an example where you will need to decide what to do in a situation based on the rules

22:38:10 [snigtha] oh , relieved,worried about the no.s,thanks

22:38:31 [Step_1] stuff like 35 yo female diagnosed with HIV asks you not to tell husband....what do you do?

22:38:33 [butter] such as rule #6, competent person can refuse lifesaving hydration and nutrition

22:39:00 [butter] but if pt is anorexia, should resolve on court, take medical guardianship...

22:39:41 [snigtha] don't tell her husband by urself but try to make her tell

22:39:55 [butter] ask her to tell her husband, in front of doc? to make sure they will have protection?

22:39:55 [Step_1] that question is a good example because covers confidentiality and when it should be broken.

22:40:36 [snigtha] what r the answers for both these

22:41:47 [Step_1] its a tough one, if the options give a choice of asking her to meet with you and the husband to tell him, that would be optimal i think. if not, you might need to break confidentiality to protect someone. there unfortunately is not an answer provided

22:42:22 [snigtha] ok

22:43:54 [snigtha] what next?

22:44:02 [Step_1] but this gives a good example of how the question will be asked. they probably will not ask about the specific rule, but you may need to know the rule in order to get the answer....if that makes sense

22:44:31 [Step_1] lets talk about defense mechs.....what defense mech is when a headche during exam, feeling upset stomach and nausea before asking a girl out on date, ?

22:44:59 [butter] somatoform?

22:45:29 [Step_1] correct, somatoform....very good.

22:46:30 [Step_1] boyfriend broke up because she either "puts him on a pedistal or in the doghouse". what defense mech is she displaying?

22:47:57 [Step_1] other example might be "this doc is a miracle worker, but that doc is totally incompetant".

22:47:58 [snigtha] sorry,ican't contribute,didn't read defence mech, yet

22:48:17 [snigtha] splitting

22:48:37 [Step_1] yes, spittling ....good for not have read that yet

22:49:05 [snigtha] thanks

22:49:23 [Step_1] since there are so few of us today, why not pick something to discuss (aside from stuff we already did in behavioral on wed)

22:50:24 [snigtha] psychopharma

22:50:25 [Step_1] any suggestions

22:50:31 [Step_1] ok

22:51:10 [snigtha] most common side effect of clozapine?

22:51:32 [snigtha] serious i meant

22:51:47 [Step_1] agranulocytosis....get cbcs

22:51:53 [butter] tardive kinesia

22:52:42 [snigtha] agranulocytosis, check bloods every weekly if possible

22:52:57 [butter] oh clozapine doesn't have TD right?

22:53:05 [Step_1] i thought that clozapine was known for not having TD?

22:53:14 [butter] that's its advantage

22:53:28 [snigtha] no extra pyramidal symptoms with clozapine

22:53:39 [Step_1] ah....thats true

22:55:26 [Step_1] pt has hypertensive crisis and is on MAO inhibitors. what foods did she likely have?

22:55:49 [butter] cheese?

22:55:53 [butter] tyromine?

22:56:01 [snigtha] cheese,fish,avacadoes

22:56:23 [snigtha] chacolate

22:56:36 [Step_1] cheese, dried fish, sauerkraut, sausage, chocolate, avocados.....all have tyramine....very good

22:57:28 [snigtha] right,thanks

22:57:44 [Step_1] same pt 2 weeks later has general restlessness, sweating, insomnia, nausea, diarrhea, cramps, delerium. what med caused this?

22:58:27 [butter] sounds like too much 5-HT

22:59:17 [Step_1] she is having serotonin syndrome caused by MAOI and SSRI combo (also can be caused by high does SSRI alone)

22:59:53 [snigtha] a patient is on lithium for bipolar disorder,lab tests show 2 m Eq/l,whatz ur next step

23:00:23 [butter] stop lithium first

23:01:03 [Step_1] above 2.5 would be hemodialysis. but agree with butter....stop lithium

23:01:53 [snigtha] right,and keep watching, they may b need for dialysis

23:03:07 [Step_1] mc side effect of trazodone?

23:03:42 [butter] what's mc ?

23:04:15 [Step_1] sorry....mc=most common and mcc= most common cause

23:04:20 [snigtha] most common

23:04:29 [butter] oh i see

23:04:43 [snigtha] sedation

23:05:06 [Step_1] trazodone is known to cause priapism

23:05:36 [Step_1] but it also is effective at improving sleep quality

23:06:14 [Step_1] what is the drug of choice for generalized anxiety disorder?

23:06:24 [snigtha] so sedation is not aside effect anymore

23:06:44 wisdom enters this room

23:06:48 [butter] diazepin?

23:06:55 [snigtha] alprpzolam

23:07:11 [Step_1] it is still a side effect, but priapism is the buzz word to know about it

23:07:22 [Step_1] hi wisdom

23:07:35 [wisdom] hi step 1

23:07:47 [snigtha] ok

23:08:01 [snigtha] hi wisdom

23:08:23 [Step_1] this is a tough one because it has changed recently. buspirone is the new drug of choice for generalized anxiety disorder because less side effects....but takes one week for effects to take place

23:08:48 [Step_1] also less abuse potential and no withdrawal effects

23:08:53 [wisdom] hi snigtha

23:09:47 [Step_1] wisdom, we were just discussing pharmacotherapy for behavioral

23:10:27 [wisdom] ok

23:11:07 [snigtha] thanks step1,donno this b4

23:11:43 [Step_1] no prob......what other subject did you want to discuss within behavioral?

23:12:52 [snigtha] higher functions

23:13:46 [Step_1] do you mean like the neurotrans and pathways and stuff?

23:14:53 [snigtha] no, cortical functions but don't mind the one u suggested

23:15:29 [Step_1] no thats fine too

23:16:38 [snigtha] why do person denies blindness in cortical blindness

23:17:11 [Step_1] they are not aware of it

23:17:28 [snigtha] i too don't know, open for discussion

23:18:04 [Step_1] denial of illness (anosognosia) in lesions of non-dominant lobe

23:19:42 [Step_1] i guess thats called antons syndrome, but i'm not too familiar with it

23:19:58 [butter] because there is internal input to make up vision that doesn't exist?

23:20:17 [butter] i only found this in my notes

23:21:17 [snigtha] , cort blindness occurs occipetal lesions,anosognosia in parietal lesions(non dominant)

23:21:55 [Step_1] good point, i'm not too familiar with it, let me look it up to see what i can find

23:21:58 snigtha exits from this room

23:22:36 snigtha enters this room

23:25:35 [snigtha] but all reflexes r normal and lokks like he person is malingering

23:26:13 [Step_1] Many patients with Anton's syndrome have associated parietal lobe lesions and sensory neglect. They may deny sensory deficits in other modalities in addition to vision. Some patients have a general dementia, and others are recovering from coma and delirium when they manifest denial of cortical blin

23:27:14 [snigtha] ok,thanks step1

23:27:56 [Step_1] i think that not all cortical blindness involves denial. when it has denial, then called antons syndrom, inwhich case likely also involves parietal lobe....thats what i got from that.....does that sound right?

23:28:25 [snigtha] yeah, i think this is right

23:28:36 [butter] yeh

23:28:59 [wisdom] i think so

23:29:11 [Step_1] pt has touble repeating statements and speaking, but comprehension is in tact. what dx?

23:29:39 [butter] Broca aphasia

23:29:43 [butter] or expressive

23:29:43 [snigtha] broca's aphasia

23:29:44 [hutals] brocas aphasia

23:29:50 [butter] or motor

23:29:53 [butter] same thing

23:30:27 [wisdom] broca aphasia has broken speech

23:30:28 [Step_1] BROcas is right because "BROken speech"

23:30:41 [butter]

23:30:49 [Step_1] what if comprehension was impaired?

23:31:05 [butter] Wernicke's, receptive

23:31:08 [snigtha] wernicke's

23:31:24 [butter] word salad

23:31:26 [wisdom] wernicke

23:31:36 [Step_1] impaired comprehension is wernicke's aphasia. i just think of an alcoholic with "wernicke's" who has no comprehension

23:31:51 [snigtha] what if repetetion is intact?

23:32:08 [wisdom] delirium

23:33:01 [Step_1] not sure?

23:33:15 [butter] what do you mean by repetition is intact? what's abnormal then?

23:33:31 [snigtha] transcortical aphasia with lesion of pre frontal cortex

23:33:57 [Step_1] interesting....didnt know that

23:34:20 [wisdom] good point snigtha

23:34:46 [butter] i don't get it, one can repeat but can't speak?

23:34:56 [snigtha] in all other aphasias, they fail to repeat any statement

23:36:30 [butter] just looked, pt can't initiate but can repeat

23:37:24 [butter] i see, thank you.

23:38:01 [Step_1] limbic system functions?

23:38:29 [snigtha] emotions

23:38:39 [butter] memory,mood,feed,mate

23:39:15 [butter] also visceral (smell)

23:39:19 [Step_1] very good. here is an easy way to remember it.....responsible for the famous 5 F's.....Feeding, Fighting, Feeling, Flight and sex

23:41:13 [snigtha] nice way to remember

23:41:40 [Step_1] pt has disinhibited behavior, hypersexuality, high rage threshold, no fear of natural enemies. what dx?

23:41:54 [snigtha] any other topics for today?

23:42:08 [snigtha] kluver bucy syndrome

23:42:30 [wisdom] kluverbucy syndrome

23:42:49 [Step_1] yes, thats correct.....you all know your stuff well

23:43:12 [Step_1] i think we covered about everything unless there is anything in particluar you want to go over?

23:43:13 [wisdom] destruction of amygdala...

23:43:41 [butter] oh, so pt will be inhibited?

23:43:42 [snigtha] not from my side#

23:44:00 [wisdom] ok

23:44:39 [butter] yeh disinhibited... just looked again

23:44:45 [Step_1] DISinhibited behavior, but also tame

23:44:51 [butter] this is great way to remember things

23:46:00 [Step_1] ok, i guess we can call it a night since we've covered everything. not as many people participated tonight, but still a great chat.....thanks to everyone for chatting.

23:46:23 [butter] when's the next discussion and what subject?

23:46:26 [wisdom] thanks and bye

23:46:37 [snigtha] very poor in stats, welcome advice fro u friends

23:48:17 [Step_1] so will see everyone on wed for neuro and histo.....snigtha, what kind of advice

23:48:39 [butter] great, thank you all

23:48:48 [Step_1] oops, forgot about goljan path on tues

23:48:58 [butter] sounds good too

23:49:03 [snigtha] any easy ways to remember the stuff

23:49:10 [butter] 9pm eastern standard time still?

23:49:27 [snigtha] next week is anat, isn;t it?

23:49:31 [Step_1] yep 9pm eastern

23:49:50 [butter] nice meeting you all guys

23:50:05 [snigtha] ok, bye

23:50:14 [Step_1] yes, wed and sat is anatomy, but also on every tues this month we are covering goljan path subjects because such a large subject

23:50:15 [butter] bye bye

23:50:20 [snigtha] thanks alot

23:50:56 [snigtha] ok, what topics in path

23:51:05 [Step_1] snigtha....you should read the last behavioral transcript because we covered biostats with some good mneumonics

23:51:29 [snigtha] thanks step 1

23:52:02 [Step_1] topics for path listed here http://www.valuemd.com/viewtopic.php?t=21255

23:52:32 [snigtha] ok, c u all on tuesday.bye

23:52:45 [Step_1] and the last behav trans is here http://www.valuemd.com/viewtopic.php?t=21533

23:52:54 [Step_1] ok good night all

23:53:12 [hutals] thanks and bye